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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ! di li 6z4 5 PID: <br /> DESCRIPTION OF WORK: <br /> ZONING REVIEW BY: C3p ( - DATE APPROVED: <br /> BUILDING REVIEW BY: , Q (...QA,1".8„,_ DATE APPROVED: .5"..7-5- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes SEWER CONNECTION <br /> STATE SURCHARGE Yes - No WATER CONNECTION <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes No h/ SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: Rg-ta <br /> Fire Department: (A Colkc: Post Office: ,,j,mis.,4--n4 School District: OR-0"W <br /> Lot Area: z2FJ a9o15:2s Rca-es Width: 0.323.4 Depth: 9,Z1 <br /> Survey Submitted: Yes X No Date of Survey: 44-8.74 <br /> -- Ont lsI LC <br /> Proposed Setbacks: <br /> Front (Lake) : Si$ Right Side: 100 <br /> Rear (Street) : 2,,r;„: 4- Left Side: 2-0014- <br /> Adjacent <br /> oo1 "-Adjacent Structures: 0# Wetland: A//4 <br /> Building Height: Def . Hgt. O.I- Peak Hgt. 0 . (< <br /> Avg. Setback: Lot Coverage: <br /> g <br /> xisting Pr. .osed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 <br /> 500-100 ' <br /> Hardcover Variance R=quire. : Yes o Date of Council Approval: <br /> Grading: Sta f Appro al D-te: By: Council Apvroval Date: <br /> Septic: StaFf Approv-1 D-te: By: <br /> Zoning Fil= :# Resolutio # : Resolution Date: <br /> REMARKS ( ' I house) : <br />