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CHECK OFF LIST FOR ISSUANCE OF PERIVIITS <br /> FOR OFFICE USE ONLY- <br /> ADDRESS OR LEGAL: Lf - <br /> po: <br /> MSCRIP'I'ION OF WORK: 012--c-ac . <br /> ------ ------------------------------------------------- <br /> ilUILDING, <br /> �- <br /> ON.- UNG REVIEW BY: DATE APPROVED: 8-Tz-oma <br /> REVIEW BY: DATE APPROVED; -2-L- <br /> -- ----- -----0- ----- <br /> �EES TO BE CHARGED: Misc. Fees Calculated By: <br /> �ERMIT Yes V-1, No <br /> ?LAN REVIEW Yes V-" No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> ;SAC Yes No, • lz SITEINSPECTION <br /> Number of SAC-Units <br /> OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: <br /> Post Office: School District: <br /> Lot Area: Sq.ft. l "t(,Sr Acres Width Depth <br /> Survey Submitted: Yes Zc_ No Date of Survey: f3 16 03 <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: `12 <br /> Rear(Street): l 0$ Left Side: -71 <br /> Adjacent Structures: Arno <br /> Wetland: N/r4 <br /> Building Height: Def. Hgt. /v /A Peak Hgt. <br /> Lot Coverage: ►0 -- <br /> Grading: Staff Approval Date: _/V By: Council Approval Date: <br /> I <br /> Septic: Staff Approval Date: _ R-3 By: <br /> Zoning File: Resolution: _ Resolution Date: <br /> Shoreland District: ..1-PS <br /> Avg. Setback: w// _ Bluff Setback: �///1 Loc Coverage: 1 <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' -z- <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No K_ Date of Council Approvz: <br /> i <br /> RENL0,RKS ('Ln house) <br />