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( ' <br /> �CHECK OFF �IST FOR ISSUANCE 4F �E�'l�IITS <br /> FOR OFFICE USE ONL'Y� � . <br /> p�DDRESS OR LEGAL: <br /> • � �'p /V�U f f7� �ShQ�P � �,�e <br /> PID� . <br /> JJESCRIPTI�N OF WORK: � -------- <br /> ---------------- <br /> ------------------------------ <br /> ___------ pATE A.PP�OYED: I ' <br /> �OYT�TG RE��V 13Y: ' . <br /> � • DA.TE APPROYED; �- �e -a�� <br /> �UIZDIrIG REVIE�4V BY: • • . � <br /> k'EES TO BE C�T.A.RGEA' r� Misc. Fees Calculated By: <br /> P��T f No _ <br /> AN REVIE`V � � Yes � No _ SE�VER C�i�iNEC�'ION _ <br /> PL Na tiVATER,CONNBCTIO�T <br /> STATE SURCHARGE YeS � No ✓ PARK F�,E <br /> INVESTIGATION FEE YeS No � SJTEINSPECTTON <br /> SAC Yes - � <br /> er of SAC•Uruts pA,=6 �rsg9 OTHER (specify) . <br /> --Numb ------------------------------------------------------------�-------------------------------------------- � <br /> ZOYL.�tG' CI�.CK LIST zoo.ing Districc: � <br /> ' Post Office: School District: • � <br /> Fire Dep3rtment: . � � <br /> Lot Area: Sq.ft. Acres . Widch '(d� DeP� <br /> Survey Submitted: Yes <br /> �o Date of Survey: <br /> Proposed Setbacics': 22 h<-✓� , /� ' : <br /> Froat ELake): � R�ide: <br /> Rear(Street): �J� �Side: � �� <br /> Ad;acent St:vctures; �'1 �' <br /> tiVetl2nd: n� <br /> r � � <br /> Buildin; Hei�t: DeF. Hgt. Peak H;t. _�_ � <br /> Lot Covera�e: �D <br /> g Councii Approval Date: �i� _— <br /> Gradi..na: Scaff Approval Date: y�� """�`�` —� <br /> Szptic; Scaff Approva! Date: _' " � " �Y' �'`J� <br /> '� q,�Resvlution: R Resolution Date: �S� 0� <br /> Zoain� File: �Q�.� <br /> Sho:eland Districc: �!COVE[2j2: D�C— <br /> Avg. Se[bacc:: OlC �!�f`SetSack: l'1� <br /> �ts��o Proposed <br /> Haceco��er: G-7�' _______-- ��2 `f�`f���a� <br /> 7�-250' — � � <br /> 2a��-5���' 3 IS ( l l� 3 � <br /> �����-�M� � <br /> ~f \;� \/ Ui:.l V: �Vt__.. nv: � -�• �---- <br /> �-r?-eca<<e� 'ti'z�:�c� Re.u�.:e�: .es YY.__ . ' - <br /> r.L�L`�R��S r.Ln.ho��se): <br />