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A�erage l.akeshare S�tback �1uff <br /> �horelanc� D�strict N�CIA�Q Permit Ni�t? <br /> � Yes Q <br /> !� Yes �& No Permit Number: i3 Yes t� No a �/A No <br /> t� N/A—see attached Setback: ' <br /> Stormwater f�uality Exisfing Proposed • ° <br /> O�erlay-District Tier Hardcover Ftardcaver Variance Required CUP Required <br /> circle one %and s %and s <br /> 0 Yes C! No I7 Yes 0 No <br /> 1 2 3 4 5 TyPe�S)� T�e�s�� <br /> Fees to be Char ed YES NO ' <br /> P�Tmit ; �-'r <br /> .Plan Review �°` <br /> �tate SurCha�'ge _ ` , � ' : <br /> Investigation Fee - <br /> SAC-Number of SAC Units ' : <br /> Other(specify) <br /> S uare Foota e $ er S uare Foota e <br /> Basement X _ $ <br /> 1�Fioor ; X "' $ <br /> 2^�Fioor X � $ <br /> Garage X = $ , <br /> : ,�,�' <br /> Esttmated Construction Vatue: --- <br /> Orono inspections Required Work�equiring Separate Permits <br /> � Fooling C� Site Plumbing t7 Grading IFilling <br /> C] Poured WaU � Siit Fence/Erosion Control echanical � �ire <br /> � Founciation Sunrey 17 Hardcover Removai O 5eptic � �3`Water�onnection <br /> � Foundatiorr Water�roofing :� Other(specify) �i'Fireplace D SeWer�onnection <br /> raming L7 Masonry 17 Law�lrrigation <br /> nsutation <br /> t] Mfg. � Landscaping <br /> � As-6uiit Survey L7; Other,,{speci#y� <br /> Final , <br /> 0 Lathe Required Stata Permi#s <br /> ���� Other{speci#y} � � � <br /> Ci Well Electrical . <br /> RENf�RKS tin-house): ` <br /> OFFiC1AL REM/�RKS-TO BE N�TED ON PERMIT AND iNITlAL1.ED: ; <br /> � See Builder�►cknovvtecfgement Form <br /> 0 Prior to releaseaf escrow money an as-built survey and hardcnver calculafions must be submitted and approved. <br /> Updated: October 2015 <br /> ��\fnrmclnlan eaviow r.harklic4 1(1_9Mri rinrv <br />