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�hareland �i�trict ����,r� �����g �>. ��erag� Lakeshor� Setback Biu� <br /> f�i�fi? <br /> ❑ Yes � �o �ermit Number: ` ` Q Yes €� �!o � ��A � Ye No � <br /> � N/A—see attached Setback: <br /> Stormwater(�uaiity �xistir�g Prop�sed <br /> Overlay District Tier Hardcover liardcover Variarrce Requirec� CU� Required <br /> circle one % and sf % and sf <br /> � Yes Q No Ct Yes Q No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fee� �� be Char ec6 Y�� f�Q <br /> PeEm it � <br /> P[an I�evieKr +�,^ <br /> State Surcharge i./' <br /> investigation Fee L/ <br /> SAC— Number of SAC Units �✓"' <br /> Other(specif�) �/ <br /> �c�e�are Foot�.�e $ per Sc�uar� Foata e <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> Znd Floo� X = $ <br /> Garage X = $ <br /> r-a,�� �� <br /> ��timatecE Construction �alue: $ �� �' �� <br /> Oror�o inspecfions Required lhfork F�equirir�g Separate Permit� <br /> �Footing � Site � Plumbing � Grading/Filling <br /> ❑ Poured Wall � Silt Fence/Erosion Controf ❑ Mechanical ❑ Fire <br /> � Fo�ndatioe� Surv�y ❑ Hardcover Removal � Septic a Water Connection <br /> � Foundation Waterproofing � Other(specify) ❑ Fireplace E3 Sewer Connection <br /> �Framing 0 Masonry ❑ Lawn Irrigation <br /> a Insulation � Mfg. C� Landscaping <br /> Q As-Built Sur�e� ❑ Other(specify) <br /> Final <br /> Q Lathe Rec{uired �tate Permit� <br /> ❑ Other(specify) <br /> ❑ Weli � Electrical <br /> E�EF�l�E�F�� (in-house): <br /> OFFECEA� �Et��oi�f�t� -TQ BE �OTEQ Ol� PERftAIT�4.[�D INtTl�4L�E�: <br /> - ❑ �ee �uile�er F.ckr��wled�err���t Form <br /> ,: <br /> '` � Prior te release of escro�v money an as-builf survey and hardcover calculations must be submitted and approved. <br /> � <br /> Updated: October 2015 <br /> ��\fnrmc\nlan rcvic�ai rho�klict 1(1_9(14F rin�v <br />