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CHECX OFF LIST FOR ISSIIANCE OF PL�RMITS <br /> • • - FOR O�FICE USE ONLY <br /> ADDRESS OR LEGAL: Z S(�S NV S/�F�rC� D!e pID: <br /> DESCRIPTION OF WORR: (���10 C,� Po 2Lt-f - G t-►-�r4rvG P �e� u� <br /> ------------------------- ----------------- ------------- <br /> ZONING REVIEW BY: DATE APPROVED: j'� '� 3 <br /> BIIILDING REVIEW BY: DATE APPROVED: S � -43 <br /> FEES TO BE CHARGED: Misc. Fees Calculated 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 D strict: <br /> Fire Department: Post Office: School is rict: <br /> � <br /> Lot Area: Width: Depth: <br /> Survey Submitted: es No Da e of S rvey: <br /> Proposed Setback : <br /> Front (Lak ) : ight S ' e: <br /> Rear (Stre t) : Left Si e: <br /> Adjacent truct es: Wetlan : <br /> Building Heig . Def Hgt. Pe Hgt. <br /> Avg. Setback: Lot Cove age: <br /> E isting Propo ed <br /> Hardcover: 0 75 ' <br /> 75 250 ' <br /> 250 500 ' <br /> 500 1000 ' <br /> Hardcover ariance Req ir d: Ye Date of Council pprova�: <br /> Grading: taff Approva ate: By: Council App oval Date: <br /> Septic: taff Approval. ate: • BY= <br /> Zoning F' le:# Resolu i # : Resolutio Date: <br /> REHiARRS (in house) : <br />