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`. ,.� <br /> k � <br /> Shorelart� QEstrict ���p�ermi4 �° �' Average Lakeshore S�tback � ���� <br /> � Itl1el! <br /> Yes !7 No <br /> Permit Number: �, .. ��� E� Yes C� No N/A � Ye No <br /> � N/A-see attached Setback: <br /> Storrrtwater C��ality EnE�ting Proposed <br /> Overlay District Tier Hardcover Har�cover Variance Requirect CUP Required <br /> circle one %and s %and s <br /> ��'.g�.p� O Yes [7 No � Yes � No <br /> 1 � 3 4 � ��S� T�e(S). T�e(S). <br /> Fees to be Char ed YES NO <br /> Permit � <br /> Plan Review <br /> State Sutrcttarge t/' <br /> Investigation Fee v' <br /> SAC-Number of SAC Ur�its C� <br /> Other(specify) <br /> S uare Foota e � er 5 uare Foot e <br /> Basement X � � �J� ' $ ""r <br /> 1�Fioor (� : X � - ' � <br /> 2"� Floor X ' � <br /> Garage X - � <br /> � <br /> Estimated Construction Value: ����0 <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing O Site Plumbing � Grading/Filling <br /> O Poured Wall Silt fence/Erosion Controi Mechanical q Fire <br /> � Foundation Survey 0 ardcover Removal G Septia 0 Water Connection <br /> Fo�ndation Waterproo�ng 0 Other(speafy) � Fireplace � Sewer Connection : <br /> Framing 0 Masonry 0 Lawn irrigation <br /> Insulation � Mfg. 0 Landscapang <br /> As-Bui1t Swrvey � Other(specify) <br /> Final <br /> � �athe Required State Permits <br /> � Other(specify) <br /> Q Weli Electrical <br /> REMARKS (in-house): <br /> OFFlCIAt.RE(iRARKS=TQ BE NOTED QN PERKIT AND tNIT1ALLED: <br /> See Builder Acknovrfedgement Form � <br /> ' to rel o escrow m ' survey a ca 'ons e submitted,and approved. <br /> Updated: October 2015 <br /> �•\fnrmc\nlan ravioui nhorklief 1fL9f11.ri rinrv . <br />