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�CTiEC�K O7�F i�IS'7' FOR ISSUANCE �'�' ����TS <br /> FOR OFFICE USE ONLY� � <br /> AI?DRESS OR LE�AL: " ,.�� ���� 2"�'�� . <br /> PID: <br /> 77ESCRIPZ'�O� OF WORK �ZK� �-CG2S s �" <br /> v---------------- <br /> --------------------------- -�- <br /> --- ,�`V BY: ^-----------�' �_' DA'I'E APP�OVED: 11� <br /> Z4�tG �2E -- DATE APPROVED; � --r..3 _�� <br /> �UII�IILNG REVIEtiY $Y: � � <br /> FEES TO BE C�-7ARGEA: Misc. Fees Calculated By: <br /> PERivLIT Yes � No <br /> PLAI�I REVIE`V � � Yes f No SE�VE.R CO�TNECTION <br /> STATE SURCHARGE Yes —� No tiVA��CONNECTION <br /> INVESTIGATION FEE Yes No -� PARK FEE <br /> SAC Yes No � STTEINSPECTION . <br /> Number of SAC�Units OTHER (specify) _ <br /> �,p�t��tG CH�CK LIST Zoaing District: ` . <br /> � Fos[Office; School District: � <br /> Fire Depart.ment: � — <br /> Lot Area: Sq.ft. t � � � Acres � . �C'� Width t " " Depth <br /> Survey Submitted: Yes �o <br /> Date of Survey: C� I Z' G�� <br /> Proposed SetbacicS: 3 O� Y�' V ' . 5/ . , <br /> ..Ese$t(Lake): .– �r1t�ide: <br /> g��1''` / <br /> �eer(S[reet): `1,hT Le�Side: � <br /> rrl��3CP�� Stniri�llz5: �j1Ptl�*Cl: <br /> Suililin� Hei�h[: DeF, Hg[. /'L� Peak Hgt. <br /> Lot Covera�e: �� <br /> g Council_Approval Da[e: ' <br /> Gradin�: Staff Approval Date: Y� <br /> � � "�? �y� �-�'- ` <br /> Septic; Staff Aporova! Date: �� a <br /> 33 Resolution: rt �1�� cY +`�Psol�tioa Da[e: 3 td � ►�" `�� ���� u <br /> 7oain� Flle: � �� <br /> Shorzlznd �ist[ict: I� <br /> Avg. Se[bz�t_: B!�f:Se[`uack: Lo:Covera�e: <br /> E�stiea Proposed <br /> Hzdcover: G-7�, �� 7;� � <br /> 7�-2�0� <br /> , - <br /> 2�v-���.; <br /> �C��-iCs�^�' � <br /> �--1arC•�0`:2i C�'�,"':�" L`��tilS'.i2�: `I2� � ,'Q J=-- �''� �r..v'�._=� n:._" �: V/"� (.' <br /> �.T�L'�:�� �.Ln ho��e): <br />