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�average Lakeshore Setback 8��� <br /> Shorelanci District WiC1ND Permit Met? <br /> Permit Number: � Yes 0 No Ct N/A � Yes C7 <br /> � Yes E� No No <br /> C� N/A-see attached S e t b a c k: <br /> Stormwater Quality Existing Proposed <br /> Overlay Distrfct Tier Hardcover Hardcover Vartance Required CUP Required <br /> circle one %and s %and s <br /> L7 Yes L7 No � Yes 0 No <br /> 1 2 3 4 5 TYP�S): Type(s): <br /> Fees to be Char ed � . N� <br /> ��k <br /> Pian Review t/� . <br /> St�te St�rs�, <br /> investigation Fee <br /> ,._ , <br /> SA�-Nt�i�b�'o�f SAC liri3�s . ' . -: y., �. , .., <br /> Other(sPecffY) <br /> S uare Foo e $ er S ua�e Foot e <br /> Base►nent X = $ <br /> 9�Eloor � - $ <br /> 2^� Floor X - � <br /> Garage X = $ <br /> Estimated Construction Value: <br /> . � � � <br /> Orono inspections Required VNork Requiring Separate Permfts <br /> 0 Footing D Site Plumbing O Grading/Fitling <br /> Q Poured Wali � Silt�encs/Erosion'Conttoi Mechanical � 'Fire <br /> 0 Faundation Sur�re y G Hardcover Removal C7 Sep�c O Water Connection <br /> C� foundation Waterproofing G Other(specify) !7 firepiace C! Sewer Conn e c f ion <br /> Framing � Masonry � Lawn lmgation <br /> insulation O Mfg, � Landscaping <br /> O As-Buiit Survey q Other{specify) <br /> Finai , , <br /> � Lathe Required State Permits <br /> Q 0ther(specify)' <br /> � Well Electrical <br /> REMARKS(in-house): - ` <br /> OFFfC1AL REMARKS-TO BE NOTED ON PERMIT AND INtTtALLED: <br /> Ci See Builc�er Acknowiedgem�nt Form <br /> � Prior to release of escrow money an as-built survey and hardcover calculations must,be submifted and approved. <br /> Updated: October 2015 <br /> rlfnrmclnlan roviow nhaeklicf 1f1_9(11.F rinrr <br />