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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 11/0 LIST FARM ROAO . <br /> PID: di— i13 i'1' `N e" 1 <br /> DESCRIPTION OF WORK: New t?.c S. <br /> ZONING REVIEW BY: .zQ DATE APPROVED: -(o- --- <br /> BUILDING REVIEW BY• c DATE APPRO <br /> VEI: �-r. • 1.� <br /> FEES TO BE CHARGED: - Misc. Fees Calculated By: — <br /> PERMIT Yes ✓' No <br /> PLAN REVIEW Yes v No SEWER CONNECTION <br /> STATE SURCHARGE Yes (.--' No WATER.CONNECTION <br /> INVESTIGATION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECT ION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: L,2•)/} <br /> Fire Department: Loj , (/v- Post Office: Coort.,(A(ce School District: bRG,uO • <br /> Lot Area: Sq.ft. No C m4,0 <br /> Acres Width Depth <br /> Survey Submitted: Yes oc- No Date of Survey: 7-7-9f <br /> Proposed Setbacks: <br /> Front (Lake): . 24,0 I '± Right Side: 62,7 <br /> Rear(Street): ?op( f Left Side: ((,p <br /> Adjacent Structures: N/l4• Wetland: ,t//A <br /> Building Height: Def. Hgt. tui t Peak Hgt. '36 <br /> • <br /> Lot Coverage: pi (A. <br /> Grading: Staff Approval Date: 'g 40 -fig, . By: �0 ‘ Council Approval Date: f./04- <br /> Septic: Staff Approval Date: ib -(9• cc!) By; S w <br /> Zoning File: # Resolution: # Resolution Date:• • <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> O < Hardcover: 0-75' <br /> 75-250' . <br /> 250-500' . <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> i <br /> REMARKS (in house): <br /> N‘ •26 . <br />