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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 4/6 5 <br /> PID: <br /> DESCRIPTION OF WORK: 014/1 <br /> ZOINE TG REVIEW BY: DATE APPROVED: /y-3/- cj 3 <br /> BUILDING REVIEW BY: DATE APPROVED; to- 31 .0 3 <br /> FEES TO BE CSARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes r/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATERCONNECTION <br /> INVESTIGATION' FEE Yes No PARK FEE <br /> SAC Yes No SI TEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: 12a-1A <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. ZS°t I 1 t Acres 5•°!q G Width Depth <br /> Survey Submitted: Yes j(— No Date of Survey: <br /> Proposed Setbacks: <br /> Front(bake): z2� Right Side: <br /> Rear(Street): Left Side: <br /> Adjacent Structures: Wetland: N 1 A <br /> Building Height: Def. Hgt. b 1c Peak Hgt. <br /> Lot Coverage: tv f4 <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: #D 3-29141 Resolution: # Resolution Date: /O-Z7-03 <br /> Shoreland District: �1 <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover. 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />