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a l�;�i� <br /> Shorela�n� C�@:�tricY RF�f�[� �e�rr�§� � ;;`ti ��� '`£ �ber��e �akeshore Se4:�acf� Blu� <br /> ,;�s F��t? <br /> Yes No Permit Number: ���-��j� � Yes � No �/A � Yes�o <br /> � � <br /> j bpe ��o � N/A-see attached Setback� <br /> �tormwrat�r�u�Ei�+ �x6�ting Propo�ed <br /> Ov��Ba�@�i�tr6cti'E'i�� F�ae¢9co�ec E�ardcovee Varoarrce Req��rec� C�iR E�eQuir�cE <br /> circle one %and s %and s <br /> b L p ' � Yes o O Yes No <br /> 1 2 /� 1�� 4 5 �� iv � TYPe(S)' TYPe(S)� <br /> / �s G <br /> Fees to be Char �d YE� �1O <br /> A��4 � <br /> Plan R�v6�wr � <br /> S�Sa�+c6�r� r/` <br /> Investigafion F�e <br /> �C- o�S�C 1�t9� l/' <br /> Other(apecify) � <br /> S c�are�oot� e � r S uar� Foota e <br /> Basement X = � <br /> 1�Floor X = $ <br /> 2"a Floor � - $ <br /> Garage X - $ <br /> 7 O � <br /> Estam�sted Constre�ct�oe�Valea�; � <br /> Orono Inspections Required 1ldoek Requiring Separate Perme� <br /> Footing � Site Plumbing � Grading/Filling <br /> Poured Wall Silt Fence/Erosion Control Mechanical Cj Fire <br /> foundati�n Survey � Hardcover Removal Septic 6 Vllater Connection <br /> �foundation Waterproofing � Other(specify) Fireplace � Sewer Connection <br /> �Fcaming � Masonry � Lawn irrigation <br /> Insulafion �Mlfg. � Landscaping <br /> As-Be�i6t Sucdey � Other(specify) <br /> Fina1 <br /> �Lathe 6�eq�aired SY�ate Perr�fts <br /> � Other(specify) <br /> Well Electricai <br /> RENiI�EtKS (in-house): <br /> OFFICI�L RE1��F�K�-'�O �E NO'FED �!� PER�ET��d�4N�'FIALl.ED: <br /> L� S�e��ilcl� � �.cknewisdgerr�ent Focm <br /> � Prior to releas of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �•\fnrmc\nlan rAviow rhockliet 1f�9f11�,rinrv <br />