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CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ♦ ' <br /> ADDRESS OR I,EGAL: /SYa /�D� S% PID: <br /> DESCRIPTION OF WORR: ��=�-t� <br /> ---------- ---,p-------------------------------- <br /> ZONING REVIEW BY:_ C���.�o C�N+�w._ DATE APPROVSD: Co' `{`S' � <br /> BIIILDING RL�IEW BY: �Xr � DATS APPROVED: � - `{- `� 3 <br /> ------------------- - <br /> FEES TO BE CHARGED� Misc. Fees Cal.culated By: <br /> PERMIT Yes ✓ No - <br /> PLAN REVIEW Yes ✓ No SEWER CONNECTION <br /> STATE SURCHARGE Yes r/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No � PARR FEE <br /> SAC � Yes No � SITE INSPECTION <br /> Number of SAC IInits OTHER (specify) <br /> --------------------------------------------------- <br /> ZONING CHEGK LIST Zoning � st ict: <br /> �� , , <br /> Fire Department: os�t Off ' ce: S ' s�c : <br /> � <br /> Lot Area: i h: D pt <br /> Survey Submitted. Yes� No Date of Survey: <br /> `l� OI�.S Fi l.�C <br /> Proposed Setbacks: <br /> Front (Isa��) : N�A Right Side: /.�� � 't <br /> Rear (S.t�-e�et-) : �30 � Lef t Side: N�/� <br /> Adjacent Structures: /�n'�u�� Wetland: /✓�A- <br /> Buil.ding Height: Def. Hg -. P ak Hgt. <br /> Avg. Setback: L t Cov rage: <br /> Exi 'ng Propo ed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Varia ce Requ' red: es o ate of Counci Approval: <br /> Grading: Staff Approval Date By: Council A proval Date: <br /> Septic: Staf Approval ate By: <br /> Zoning File � R soJ.utio �: Resolut on Date: <br /> RFl�iARKS ( " honse) : ,. <br />