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�CHEC� OFF i�IST FOR ISSUANCE OF �ERMITS <br /> FOR OFFICE USE ONLY� . . <br /> A.DDRESS ORLEGAL; 2�3� PH�-�s�l^Jr ►7�a� --- <br /> PID: <br /> DESCR.�TTO�T OF WORK: i��w•�o�c� c�s�=� ,r��-o bw-�n� <br /> zO:�i TG REV:�EW BY: --------------------- DA.T'E APPROVED: <br /> gUI�DING R.E"VIEtiV BY_� _ ---�-----------DA.1'E APPROVED__�,��z9_c�------ <br /> F'EES TO BE CHARGED: Misc. Fees Calculated By: <br /> pEg�T Xes ✓ No <br /> PLAN REV�EtiV � � Yes _� No SEti�ER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No _� PARK FEE <br /> SAC Yes No T� SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZOYI1tG CI�.CK LIST Zoning District: ✓lJ0 G�/C�e , <br /> Fire Department: Post.Office: School District: • � _ <br /> Lot Area: Sq.ft. Acres ' Width Depch <br /> Survey Submitted:� Yes No Date oE 5urvey: k <br /> Proposed Setbacksi • � <br /> Froat(Lake): Rioht Side: . <br /> Rear(Street): Left Side: <br /> Adjaceac Struccures: � etland: <br /> Builclin�Hei;hr. Def. Hgt, ealt Hgt. <br /> Lot Covera�e: <br /> Grading: ScaEf Approval Date: Council Apgroval Date: ' <br /> Szptic: Staf� Approval Dace; By: <br /> Zoain� File: R Resolutioo: # Res lucion Date: <br /> Shorela.nd District: <br /> Av;. Setback: BluFf Setback: L,ot Coverage: <br /> Eustino Proposed <br /> Kzdco�er: 0-75' <br /> 75-250' <br /> 2�0-SCxJ' <br /> �oa-ioc�o� <br /> ��'��CGt�i tr c=i?�C.� ti2yL'!LPC: :25 1i0 n' _ r�C_'ni��ril An�r�y��: <br /> RE�L�S (inhou�e): <br />