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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 52�64 O -O 6 O a-0 A-D PID: <br /> DESCRIPTION OF WORK: SHE to <br /> -----------------------p--,-;n--------------------------_-------- -- ----------- <br /> ZONING REVIEW BY: �yc� 1�1J DATE APPROVED: y <br /> BUILDING REVIEW BY: DATE APPROVED: Z-1- Z 9 - 53 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes-7 No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATER CONNECTION <br /> INVESTIGATION FEE Yes Nos/ PARR FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---------------------------------------------------------------�--- <br /> ZONING CHECK LIST Zoning District: d x qc- <br /> Fire Department: P s Offic S ool rict: <br /> Lot Area: Z Wi h: ept <br /> Survey Submitted: Yes No Date of Survey: (0 <br /> Proposed Setbacks: 44 Right Side: <br /> Front (Lake) : /v g <br /> Rear (Street) : f'Z <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. p ,(� Peak Hgt. c� �-- <br /> Avg. Setback: /L/ Lot Coverage: IJJA <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 25t-500' <br /> 500-1000 , � 1 <br /> • No Date of Council Approval: <br /> Hardcover Variance Required. Yes � PP <br /> Grading: Staff Approval te: By: C nc Approval Date: <br /> Septic: Staff Approval a e: BY= <br /> Zoning File:# esol tion #: Reso ution Date: <br /> REMARKS (in house) : <br />