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CHEC� OFF i,IST FOR ISSUANCE OF �'E��IITS <br /> � FOR OFFICE USE ONLY <br /> ' ADDRESS ORLEuAL: l3� c�-+�=� �µa �= <br /> PID: <br /> DESCRIP'IZON OF WORK: {L,—c,�w�p�- z N� o� — <br /> ZOYIi�tG REVIEtiV BY: `--- S� �----- DATE APPROVED: <br /> SUILDING REVIE�V BY: DATE APPROVED: z -z-o� � . <br /> FEES TO BE CK.A�ZGED: Misc. Fees Calculated By: <br /> pEg�T Yes ✓ No <br /> PLAN REVIE`V � Yes c/ No SE�VER CO�INECTION <br /> STATE SURCHARGE Yes c/ No WAZ'FRCONNECTION <br /> INVESTIGATION FEE Yes No � S�INSPECTTON <br /> SAC Yes No <br /> Number of SAC�Units OTHER (sgecify) <br /> ZONi�tG CHE.CK LIST Zoning Discrict: c� �-F �. <br /> Fire Departrnent: Post Office: ! School District: � <br /> L,oc Area; Sq.ft. Acres Widch Depth <br /> Survey Submi[ted: Yes No Date of Survey: <br /> Proposed Setbacks: ; <br /> Fron[(Lake): Right S ide: <br /> Rear (Street): Left Side: <br /> Adjaceat Structures: Wetland: <br /> auilclin� Hei�t: Def. Hgt, Pea.lt Hgt. <br /> Lot Coverage: <br /> Gradino: Staff Approval Date: By: Council Approval Date: ' <br /> Septic: Scaft Approval Date: � � Y� �� <br /> Zoning File: � Resolutioa: n Resolution Dace: <br /> i <br /> Shorel�.�d Districc: ° <br /> Avg. Setback: Bluff Setbac : L.ot Covera�e: <br /> E�iSCin� � PrOposed <br /> 0 <br /> Hardcover: 0-75' ' <br /> ?s-z�a� -� <br /> 2�o-5ao� ; <br /> �oo-laco� <br /> na�'dcov;r `;'ari�ce P.equire�: yes �% Da:e oi Co�cil :'1Y f.OV�. <br /> F.E`L�Rh.S (in hou�e): <br />