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CHECK OFF LIST FOR ISSUAIYCE OF PER1tiXITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3135 /J0�-1 Sttd�� 'OR <br /> PID: <br /> DESCRIPTIO:Y OF yflORK: 'K ��c9�� I�cw��e�- <br /> ------------------------------------------------------------------( -b <br /> ------------------------------------- � <br /> ZONI�VGREVIEtvBY: ,/� DATEAPPROVED: Z- �- s � <br /> BUILDINGREVIEWB DATEAPPR06�ED: �-��-ar <br /> ------------------------------- <br /> FEES TO BE CHARGED: �%Iisc. Fees Calcrclated By: <br /> PERI�IIT Yes � No <br /> PLANREVIE6V Yes �/ �Vo SEtiYERGOtViVECTIDtV <br /> ST�lTE SURCHARGE Yes �/ tUo tiVATER CO� tWECTIOIV <br /> I�YVESTIG,�TIOtV FEE Yes tVo ✓' PARK FEE <br /> SAC .Yes 1Vo v SITE INSPECTIO�V <br /> Nct�nber of SAC U�iits OTHER (specify) " <br /> ----------------------------------------------------------------------------------------------------- --- <br /> 2'ONIIYG CHECh'LIST Zor�ing Dish•ict: � C <br /> Fire Deparbnerrt: Post Off ce: School Dish•ict: �,. <br /> Lot.�lrea: Sq ft. fla�es YYidth Depth <br /> Sic�vey Subrnitted: Yes No Date of Stuvey: <br /> Proposed Setbacks: <br /> Froru(La/ce): Rig/it Sc e: <br /> Renr(Street): Geft Side: <br /> Adjacent Structures: 6Ve c�nd: <br /> Buildirig Height: Def. Hgt. Pe 'Kgt. <br /> Lot CoverRge: � <br /> Grctding: St�ff.4pproval Date: By: Cotencil rlpproval Dccte: <br /> Septic: StnffApproval DRte: BY� <br /> Zoning File: # Resofution: # Resolution Dnte: <br /> Shorelancl Dish•ict: <br /> Avg. Setback: Bl�cff S tback: Lat Coverage: <br /> Esistin Proposed <br /> Hardcover: 0-7�' <br /> 75-250' <br /> 250-500' �— <br /> 500-1000' <br /> Hardcaver Yariance ReQccireci: Yes o Date of Coc�ncil Approval: <br /> RE1I�IARKS;(irt Itactse): <br /> : 31 <br />