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� <br /> ' CHECR OFF LIST FOR ISSIIANCE OF PERI�SITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL DESGRIPTION: 2 � �P� l_�C� ��� �� <br /> PID: <br /> DESCFtIPTION OF WORR: �� �E' �. {��'� • <br /> --------------------------- -----------------------_--------------------------- <br /> ZONING R$VIEW BY: �!%E�'� `�� DATE APPROVED- <br /> BQILDING REVIEW BY: .DAT$ APPROVED: <br /> PERMIT ISSII$D BY: DATE: <br /> -------------------------------------------------------------------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No SEWER UNIT $ <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATER CONNECTION <br /> PENALTY Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> OTHER (specify) <br /> -------------------------------------------------------------------------------.. <br /> ZONING CHECR LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Width: Depth: <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks : <br /> Front (Lake) : Right Side: <br /> Rear (Street) : Left Side: <br /> Adjacent Structures: Wetland: <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: BY= ' <br /> Zoning File:# Resolution #: Resolution Date: <br /> �2ElrlARRS (in house) : <br />