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�Marelan� Qi�trict l�GCl�'� l�er�it �►�erac�e �.akeshore Setback . �E�� <br /> fVief? <br /> �� Yes � No Permit l�umber: ���� 1 � Yes � No �N/A � Yes�o � <br /> ° � N/A-see aftached Q,� hfL.� Setback: <br /> �.-�'t i���t C+� <br /> Storm�rvater Qu�lity Existing Pro�osed <br /> Q�ser�a� �i�t�ict�'i�� E�ae�����r F�a����N�r Varia�ce ��e��irec� C�lR R���€r�d <br /> " circle one % and s °/a and s <br /> _,v � -�; �� � �,_ :,,�� � Yes �o C'� Yes ,� t�o <br /> l e� � , . <br /> 1 i 2 3 4 5 Type(s): Type(s): <br /> y��f 4�� i ;- <br /> i <br /> �e���� be C&�a��:�d 1"E� t�� <br /> �' <br /> Pertnat c/' <br /> F�9�n ft��iev� l/` <br /> Stat��e�r�har�e �"` <br /> le�vestig�tion Fee ✓' <br /> SAE'r—N�Ei�1�l�P����C CBBtT$� <br /> Other(s�ecify) ��-- <br /> Sc�uar� �oot� � � �r S uare Foota e <br /> = Basement X = $ <br /> � 1� Floor X = $ <br /> 2nd FIo01' �' _ $ <br /> Gara�e X = $ <br /> e_l <br /> Estirr�atecf Construction �/alue: � ��.�(�� <br /> ; Oran�In�pecti�¢�� Required �ork�eqcrerirag �ep�r�te Perrnit� <br /> �Footing � SiYe E� Plumbing � Grading/ Filling <br /> � Poured Wal! � Silt Fence/Erosion Control � Mechanical ❑ Fire <br /> � Founc@ation Survey ❑ Fiardcover Removal � Septic � Water Connectinn <br /> � Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> � Framing � PVlasonry E� Lavvn Irrigation <br /> 0 Insulation � Mfg. � Landscaping <br /> �s-BuBlt��e�ey� ❑ Other(specify) <br /> inal <br /> � Lathe I�e�u6c�c€ St��� �ermEts <br /> � Other(specify) <br /> � VVell Electrical <br /> f2Ef��;i`F(S (in-house): �� ������°!� (r(�rL��• ���8 ��- C� ��l'4� �� <br /> �C��Q� �- 6�i�16�'�l� �- Y Ct�r f�� <br /> Q�FFiCO�L �EIu��,RK� ��Q� �E f��TE� o�" �E�f�RE��,E�� il���'IeR.�.�E�: <br /> C& Se� �r��ld�r��ckr��v�l�c���r�e�� F'orr� <br /> ��,. <br /> C'� prior to_rel�as�-ofi escrow money an as-built survey an�.har�co�rer calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �•\fnrtne\nlan rauio�ni rhorklic4'i(1_�(11 F rinrv <br /> }6, <br />