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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> � ADDRESS ORLEGA.L: I Z bS �3(`�AGcr� rr5 �o�.ti� ��•� <br /> PID: <br /> DESCRIPTION OF WORK: a�1 <br /> ZOrT�1i G REVIE`V BY: � DATE APPROVED: S'-/7-c S <br /> BUII�DING REVIEW BY: DATE APPROVED: 5'- i7 -�5� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes / No SEWER CONNECI'ION <br /> STATE SURCHARGE Yes � No WATF.RCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> ZOi�1IVG CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depch <br /> Survey Submitted: Yes_;� No Date of Survey: pr� r-r� <br /> Proposed Setbacks: <br /> Front (Lake): -��' { Right Side: 7�c ' '� <br /> Rear (Street): i�� ' + Left Side: z�a� ' r <br /> Adiacent Structures: r Z- � Wetland: �/ �r� <br /> Building Height: Def. Hgt. �v � �'1 Peal:Hgt. <br /> Lot Covera�e: N J Oi <br /> N��..� �u:� <br /> Grading: Staff Approval Date: �}p.2c.;c'� w ,r�t By: Council Approval Date: <br /> Septic: Staff Approval Date: N �✓� By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: �,-� <br /> Avg. SetbacT ��,� Bluff Setback: ,� /✓� I.ot Coverage: N//3 <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' �'��'�J P`'� `-`� � � <br /> 2�0-500' /�-e� 4'�^--� <br /> 500-1000' <br /> Hardcover Variance Required: Yes No_� Date of Council Approval: <br /> RENIARKS (in house): <br /> � <br />