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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: i SO No(2.'TH s wbA 02 W <br /> PID: <br /> DESCRIPTION OF WORK: <br /> ZONING REVIEW BY: A.J 104 DATE APPROVED: <br /> BUILDING REVIEW BY: DATE APPROVED: /• 6 •o�( <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAIN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes _� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: y0 G /t"i-Q <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres idth Depth <br /> Survey Submitted: Yes No ate of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hat. Peak Hat. <br /> Lot Coveraae: <br /> G.ading: Staff Approval Date: By: tutionoDacte- <br /> Shoreland <br /> Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # <br /> District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> ExistingProposed <br /> Existing <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />