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kv�rag�l.a�esttare�etback B��,� <br /> Shorelanc! Districf l�RClAID Permit � fi�et? <br /> C! Yes L� <br /> Cl Yes C� No Permit Number: � Yes � No � N/A No <br /> � N/A-see attached Setback: <br /> Stormv�rat�r t�uality Existing Proposed <br /> OveriabDist�3ct Tier Hardcover Hardcover Variance Required CUR Required <br /> circle one %and s %and s <br /> L3 Yes � No t] Yes O No <br /> 1 2 3 4 5 �YPe�S�� T�e�s�' <br /> F�'ta be Char ed YfS �1� ' <br /> Perrxat# ` <br /> Plan Review <br /> State Surcharge Y <br /> indestigation Fee v <br /> SA�-Number of SAG Units <br /> Other(specify) : . <br /> S ware foota e � er S uare Eoota e <br /> Basement X = ` $ <br /> 1�fioor X - $' <br /> 2^��loor X ' $ <br /> Garage � _ $ <br /> Estimated Construction Value: �,� ��.�._. <br /> � <br /> Orono Inspections Required Work Requiring Separate Permits. <br /> � Footing � Site lumbing � Grading/�illing <br /> �i Powred Wall � Silt Fenc�/Erosion Control C] echanical G Fire <br /> C1 Foundation Survey fl Hardcover Removai 0 Septic CJ Wafer Conr�ection <br /> 0 Fountlation Waterproofing Cf bther'(sp�cify) � Firepiaee � SewerConnection <br /> ��raming 0 Masonry � Lawn lrt`i5ation <br /> Insulation CJ INfg. C! Landsaaping <br /> C7 �s-Buitt Survey Ci Other(specify) <br /> Final <br /> � Lathe Required Stste Permits <br /> Q Other(specify� <br /> 0 Weli Electricat <br /> REMARKS (in-hous�),'. <br /> OFFIClAI, REMARKS-TO$E MOTED ON PERMIT AND lNITIALL�D: <br /> � See Buitcler Acknowiedgement Farm <br /> Q Prior to release ofi escrow money an as-built survey and hard+cover caiculations must be submitted and approved. <br /> Updated: October 2015 <br /> vlfnrmc\nlan roviow rhonklict 1fl_9f11F rtnrv <br />