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�horeland District fl�C1�� �errnit Average Lakeshore �etback ��u� <br /> Nlet? <br /> Yes � �o Permit Number: � Yes � No t�1/A � Ye No <br /> N/A—see attached Setback: <br /> Stormwater Quality Existing Proposed <br /> Overlay District Tier F�arc�cover FEardcover Variance F�equired CUP Requireci <br /> circle one % and sf % and sf <br /> � Yes No � Yes No <br /> ° 1 � 3 4 5 TYPe�s)� TYPe�s)� <br /> ;: <br /> P <br /> � <br /> � <br /> Fees to be Char e� YE� I�� <br /> ; Permit i✓` <br /> Plan Re�iew �d <br /> F State Surcharge <br /> Investigatian Fee <br /> � SAC—Number Qf Sl�C fJr�its <br /> "' Other(specify) ,_ <br /> ,: <br /> �quare Foota e � er S uar°e Foatage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> _ . ,.6..t'�� <br /> Estimatec� Construction Value: $ �' ' ° � c C';:� " <br /> � Orono Irsspections Requirec� 1Mork Requiring �epara�e Permitg <br /> 3- <br /> t. <br /> !' �Footing ❑ Site ��, Plumbing � Grading/Filling <br /> ; ❑ Poured Wal! Silt Fence/Erosion Confrol �;Mechanical � Fire <br /> E ❑ Founc�ation Survey Q Fiardcover Removal � Fireplace ❑ Water Connection <br /> � � Framing ❑ Other(specify) Q Masonry � Sewer Connection <br /> �: ❑ Waterproofing/Drain tile ❑ Nlfg. 0 Lawn Irrigation <br /> � Foundation Waterproofing � Other(specify) Q Landscaping <br /> E �Framing <br /> �', sulation <br /> �-�uilt Survey <br /> � �Final <br /> Lathe Required State Permits <br /> 0 Other(specify) <br /> � Well � Electrical <br /> REhR�t��� (in-house): <br /> s <br /> 3 <br /> OFFIC66�,L REMARK� -TO BE t��TE� Q� PEl��IT AN� IP�ITi�LLED: <br /> � ,�ee Builder Acknowledgemer�t Forera <br /> � Prior to release of escrow money an as b,urilt survey and hardcover calculations must be submitted and approved. <br /> `�!�`� `? :° t/�°.` ����i' ' 3vG 7 e 4 4 y�"'.. 't<�C�. �-f`, "� �'!� '��.- '' �f � ` �� ��i.�� � � t,s..-.ryq't� p s, c /``-., <br /> E � e� si�- c� C� - �` �� E�.`r!:�. L� �6 �''� � F✓ C� � ��'�a_ t.p'i�� <br /> � `�e.�c `}' �t��`�-��E�'��E�- /{`��f�'!'`�� _`-- <br /> ��.�:: <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />