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� <br /> � CKECg OFF i..IST FOR.ISSUANCE O�' ����TS <br /> FOR OFFICE USE ONLY� <br /> p,�}D�tESS 4R LEGAL: l 3 `� R �A r�C �� �-t'� <br /> PID: �c.P,,y,� c.�, 9�� <br /> 77ESCRIPZ'XO�T OF WORK: 2�:�'NtiN�� Gv�r-� <br /> ----------- <br /> ----------- <br /> _----_____------- ------�--/ — � �",� �`r�` pATE APPROVED: � �l 1��1 <br /> ZOVING TZEVIEtiV BY: �/� ��..-`t � � <br /> � D.A.TE APPROVED; �- `� - o� <br /> BUII�DING R.EVIE`V BY: � � <br /> �`EES TO BE C�-TA�GEA: � Misc. Fees Calculated By: <br /> P���T Yes No <br /> PLAN �tEVIEtiV � Yes No SE�YER COi�INECTION <br /> tiVATER CONNECTION <br /> STATE SURCHARGE Yes No ✓ p��{ FEE <br /> INVESTIGATION FEE �'eS gTT'EINSPECTION <br /> SAC Yes No —� <br /> OTHER (specify) <br /> Number of SAC�Units ____________________ <br /> --------------------- <br /> --------------------------- � <br /> �,pyTs�tC',- �CI�CK L�S� Zoaing District: ��"� � • <br /> Post Office: School District: � � <br /> Fire Department: . ! <br /> LotArea: Sq.ft. ���IV Acres �a�7 � Width J��'J Depth <br /> Survey Submittecl: Yes � <br /> �o Date of Survey: "I Z� b� <br /> Proposed Setbacks: �Ui/ Ac GI GL ��i tU� 1 � , f / . : <br /> [Side: �'� <br /> Froa[(Lake): CSl 1�' � • <br /> Rear (Stree[): <br /> ��1� LeFt Side: � t t''� <br /> '�d'acen� Srn�rtt�rc�: �Vet!�d: <br /> � <br /> Buil�lin� Hei�t: DeE, Hgt. Pea.l:Hgt. <br /> Lot Covera�e: I a�vlb � CjI2?�)D� s —7 <br /> ��(i�C�� Counc� A roval Date: � ''� I <br /> Gradin�: Staff Approval Date: BY� pp <br /> Szp�ic: Staff Aporov� D2te: � aY' �� <br /> � Resotutioe Da:e: � 2� I � ' <br /> 7oa�n� File: �� Resolut�oa: R______ <br /> Sho�e,and Distric�: �_ ��Cove2�?� � '�C���/C> <br /> AvQ. Setbzc':�:: Z. , ..�t' B��f�Setback: � �" <br /> ' �L���o Proposed <br /> m � �16 �Sr <br /> H�ecover: G-7S � o �Co2-1 SFZ- <br /> 7�-2�Q' __.�'2_---0 � ��1G► sF <br /> Z�U'��1'.i• �J <br /> ���0 :Cfi��, <br /> . , _a n�_ _��,. - � �.` ��__ �:: ��,.�_� .,�_-� _, �����--� <br /> �a-e�o�:e: -L'zi�.... _._�u..��. �e� <br /> r�._lL�.i-�ti �Ln h�'��): <br /> �. <br />