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- '� CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDR$SS OR LE�AL: Z.2�{O F'Ok gT�-� PID: <br /> DBSCRIPTION OF WORR: �6G-!c <br /> --------------------- ---------------- <br /> -------------_---�_----��-�----------- <br /> ZONING REVIEW BY: � ,..—. DATS APPROVSD / 3 <br /> BIIILDING REVIEW BY: <br /> DATS APPROVED: t �I <br /> ----------------------- ----------------------------------,3---------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT YeS f N� SEWER CONNECTION <br /> PLAN REVIEW Yes No <br /> STATE SURCHARGE Yes ✓� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes No v SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST -----------------Zoning District �2-�Q----------------- <br /> Fire Department: Pos f ' S ol District: <br /> Lot Area: Widt - t - <br /> Survey Submitted: Yes �C No Date of Survey: <br /> O ns ti=�L.C <br /> Proposed Setbacks : i � � <br /> Front (L�e) : N �� Right Side: -j d <br /> Rear (S�eet) : S�d �� Lef t Side: Zb0 � "'� W <br /> � � <br /> Adjacent Structures: �}TT74Ct�F�d Wetland: � ��U <br /> Building Height: Def . Hg � P k Hgt. <br /> Avg. Setback: ot Cov rage : <br /> Exis i g Propo ed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Requir d: es N te of Counc 1 Approval:_______ <br /> Grading: Staff A roval D te: By: Council pprova�. Date: <br /> Septic: Staff A proval Da e: Y= <br /> Zoning File:� e olution ResoJ.ut on Date: <br /> gE�RgS (in use) : <br />