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�d l'J <br /> / �4verage�akeshare Set(�ack <br /> Sh�reean� District iiACVIl� Permit ,.,Q� ! i��t? Blu�t � <br /> Permit Number: �' �. � 0 Yes � No �/A � Yes <br /> C� Yes No No <br /> � N/A—see attached 8etback: <br /> S�osmwater QuaEity Ex�sg@ng Proposed <br /> Overlay Dis4ric�Tier Harcicover &lardcovec Var��nce l�equired CUP Rec�uirec@ <br /> circle one %and s %and s <br /> � G Yes � Yes ; o <br /> 1 2 3 4 /5 ) � ,..-<..,.....�-� TYpe(S)� TYPe(S)� <br /> L� <br /> Fee�to be Ghar ec9 YES NO <br /> Peemi# <br />` Pian Review <br /> 9�s S�r�i�r�r ; 1�' <br /> • investiga#ion Fee <br /> �C-Numbilr of SA��tit� + <br /> Other(specify) <br /> S uare Foota e $ �r'S uaee Foota e <br /> Basement X = $ <br /> 1�Floor X _ $ <br /> �nd FIOo� . X . _ $_ <br /> Garage , X - = $ <br /> Estimated Constru�tion Yalue: � �:�C`/��vluV <br /> Orono Inspections Required 1lllork Requlrin�Separate Permits <br /> Footing � Si#e L7 Plumbing . � Grading l Filiing <br /> � Poured Wail Silt�FencelErosion Control Mechanical � Eire , <br /> � Foundatlon Survey � ar,dcov�r Remoual [3 'Septic G Water Gonnection <br /> I7 Foundation 1Nate�roofin L7 Other{specify} 17 Fire�lace 0 Sewer Conneetion <br /> 'G Framing : � 1�llasonry � Lawn Imgation : <br /> Q Insulation C! Mfg. � Landsc�ping <br /> �i As=Bullt Survey C3 Other tsP�fY) <br /> Final <br /> L] La#he Requiret!State Permits <br /> �7 Other(spe�ifi� <br /> �] WeN Electrical <br /> REAAARI�S(Fn-house): <br /> ��FtCiAL REIi6ARK$-TO BE NOTED OIV PER�IIIT ARD iiViTiALLED: <br /> � See B�ailde �ickno�nrledgement Foeera <br /> Prior to ' s o as-built survey er ca cu a be submi approve . <br /> Updated: actober 2015 <br /> ...lfn...�.c\..Inn..-....n�u wi.nnLl:o�1!1 9/�1 G.Inwv . .. <br />