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�CHECiK pFF i�IST FOR ISSUANCE O�' �E�'�TS <br /> � FOR OF CE USE ONL��� � ��G��f� Je <br /> ADDRESS ORLEirAL: � �5� NQ <br /> P17�: ' _ <br /> ]�ESCRIPITION OF WORK: IV Ev�1 " o,� cx� nw�, Q�l� � <br /> --_------------ _—_------__ __------------------------- ------------- � <br /> ZOti�i tG REVIE�V J3Y: DATE APPROVED: S <br /> � — DA,TE.AFpROVED: S z3 •o� <br /> �UII�DING REVIEtiV $Y: . <br /> FEES TO BE C�-IARGEA: � Misc. Fees Calculated By: <br /> PERNI.IT Yes ✓ No <br /> PLAN REVIEtiV � Yes -� No SE�V�E�R CO�TNECTTON <br /> STATE SURCHA.RGE Yes —� Na tiVATFRCONNECTION <br /> INVESTIGATION FEE Yes No —� PARK FEE <br /> SAC Yes No � SITELNSPECTION <br /> Number of SAC�Units ,,� �` � 03 �I•z•6� OTHER (specify) <br /> -- --------------- <br /> ----------------------------- - <br /> ZONIi�IG CTi�CK LIS�' Zoaing Districc: L� � C..� . <br /> Fire Departnlenc: <br /> Post Office: Schaol District: • <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submicted; Yes � No Date of Survey: <br /> Proposed Setbacks: Yl� '� Y� �� N ����� : <br /> ' t Side: y_ <br /> Front(Lake); � <br /> s�� �� � <br /> Rear(S[reet): �, --�cfrSide: <br /> ,�Sj3CPP,[ StntCbllc:� — <br /> ��� WP�1?�d: �1i.� <br /> Buildin� Height: DeF, Hgt, Pea1c Hgt. <br /> Lot Covera�e: <br /> B Council Approval Date: <br /> Gradlizg: Staff Approval Date: Y- <br /> Septic: Staf�Approv� Dace: /v � �Y' � <br /> Zoa�ng File: ��b'/L�� Resolutioa: n _ Resolution Date: ��L1��G 7 <br /> � 5�z,���� <br /> Shoreland Districc: i <br /> Avg. Setback: urh,r, <br /> $!LE�Setback: L.o:Cove2je; <br /> Etsti�o P:opased <br /> H�eco��er: G-7�' <br /> 7�-2�0' <br /> ��' <br /> .,^-�.,��3 <br /> � \. ' ,� _ :, . .,_ ,i. <br /> N?rCCO`ie' `�Z!c"_:.C.2 �l?yU::�2�' �i�2� .�� ll�l� Vi �.0'���:. .-�rN:� <br /> F.E�L�S (.L�ho�.�el: <br />