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, • CHECR OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: t,.��, S� �f,��:�-f��� ���c��_ /�'�-- PID- !�' ��� �) - � � �s-� c:C��� :� <br /> , <br /> DESCRIPTION OF WORK: �� ��� �:��-L ' <br /> ------------------------------------------------------------------------------� <br /> ZONING REVIEW BY: N /� _ DATE APPROVED: <br /> � L <br /> BIIILDING REVIEW BY:_ �-� ::-�___ _— - DATE APPROVED: �I-� �� -/2 <br /> --------------------- .----------------------------------------------------- <br /> FEES TO BE CHARGED: � Misc. Fees CaJ.culated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes �No WATER CONNECTION <br /> INVESTIGATION FEE Yes No �/ PARK FEE <br /> SAC Yes No ✓ SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------ <br /> ZONING CHECR LIST Zoning istrict: <br /> Fire Department: Post Offi,%ce: Sc o District: <br /> ;` <br /> Lot Area: Width: Depth <br /> Survey Submitted: Ye No Date of Survey: <br /> Proposed Setback : <br /> Front (Lak ) : Right ide: <br /> Rear (Stre t) : Left ide: <br /> Adjacent tructur s: Wetland: <br /> Buil.ding Heig t: Def . Hgt. Peak Hgt. <br /> Avg. Setback: Lot Covera e: <br /> Ex stin�g Proposed <br /> Hardcover: 0 75 ' <br /> 75 250 ' <br /> / <br /> 25 -500 ' 1 <br /> r` <br /> 500 1000 ' 0 <br /> � <br /> Hardcover Variance Re �fired : Ye No Date of Counci� App oval: <br /> Grading: Staff Approv � Date: By Council Approva Date: <br /> � <br /> Septic: Staff Approv Date : By: <br /> Zoning ile: # Reso tion # : Resolution Date: <br /> REMARR (in house) : <br />