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��,;c�--.s,.-..^.;:-rz¢-.=a�r�tr,_,•--..�:-�-'-•--zr.c..-,-:� e.,. F'- ---,,.-..,__ .�.,,.... „-_. ..,:z -'� . . -. ..:�... ... ...,R.- ,..-;c.-. ._ .Fs..f. . . . � -.. .� . .r.-..w-va <br /> .. _ ., ,. . . �rr�v _ �,'.� .� �.a�a-F-„ . , �-...-.�-3.n. :..-.,.. < �:�,<-� .s�,•n^r�.. ,. <br /> E, � _A. . ,. � . �- <br /> � <br /> �� Shoreland District 111�CWQ Permit Average Lakeshore Setback Bluff <br /> � Met? <br /> � Permit Number: 0 Yes � No � N/A 0 Yes � <br /> � Yes O No No <br /> � N/A—see attached Setback: <br /> E Storm�nrater Quality Existing Proposed <br /> Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> circle one % and sf % and sf <br /> 0 Yes � No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> �; <br /> �` <br /> � Fees to be Char ed YES �!O <br /> �;: Perm it ✓ <br /> �. Plan Review j/ <br /> � <br /> � State Surcharge �r^ <br /> � Investigation Fee f/ <br /> I <br /> �' SAC—Number of SAC llnits f�" <br /> �; Other(specify} (i— <br /> � Square Foota e $ per Square Foota e <br /> �- Basement X = $ <br /> 1 St Floor X = $ <br /> � 2nd FIoO� X = $ <br /> Garage X = $ <br /> ;� <br /> Estimated Construction Value: $ �, ��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � 0 Footing Q Site ❑ Plumbing ❑ Grading/Filling <br /> l ❑ Poured Wall � Silt Fence/Erosion Control 0 Mechanical ❑ Fire <br /> �. ❑ Foundation Survey ❑ Hardcover Removal ❑ Septic ❑ Water Connection <br /> � � Foundation Waterproofing ❑ Other(specify) � Fireplace ❑ Sewer Connection <br /> 4 <br /> �z - .�Framing � Masonry 0 Lawn Irrigation <br /> '' ❑ Insulation � Mfg. ❑ Landscaping <br /> � ❑ As-Built Survey ❑ Other(specify) <br /> Final <br /> � <br /> � Lathe Required State Permits <br /> � ❑ Other(specify) <br /> � Well ❑ Electrical <br /> REMARKS (rn-house): <br /> M <br /> { <br /> � <br /> � OFFICfAL REMARKS-TO BE NOTED ON PERMIT AND INtTIALLED: <br /> � <br /> � � �ee Builder Acknowledgement Form <br /> �' <br /> ❑ Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approveci. <br /> } <br /> t <br /> a. <br /> � <br /> t <br /> Updated: October 2015 <br /> 7•\fnrmc\nlan fp\/IP\A/rharklict 1 fl_7(11 F(Inrv <br />