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\�"�'� '�� <br /> "� '1, ANerag�Lakeshore Setback g�uff <br /> Shoreland District (�tCl�►D Permit � � 1Vlet? <br /> �o Permit Number: � -� ' � D Yes � No N/A- � Yes <br /> t7 Yes No �.t <br /> � Q N/A—see attached Setback: <br /> Stormwater Quality Exist�ng Proposed <br /> Overiay District Tier Ftardcover Hardcover Variance Required CUP Required <br /> circle one - %and s %and s .�` <br /> � Yes o ' � Yes No <br /> � 2 :3 4 ;� s� � .�._ ^ TY�(S)� ` Tme(S)� <br /> �.,�' �._ <br /> Fees to be Cha ed YES NO <br /> Per�x�it <br /> Plan Review (/� <br /> �#ate�urcharge. ` , „ <br /> Investigation Fee . <br /> SAC�-Nurnber 4'f SAC Ur�i#s . ., <br /> `Other(specify) <br /> S uare foota e $ er S uare foota e <br /> Basement X = $ <br /> 1�F1oor X = $ . <br /> 2"�Floor, : X = $ <br /> Garage X = $ , <br /> ��� � ��� <br /> Estimated Constrwction Value: <br /> Orona Inspections Required Work Requiring Separate Perinits <br /> �ooting O Site Plumbing � Grading f Filiing <br /> �Pt�ured WaN Siit Fence/Erosion Control Mechanical O.Fir� <br /> Four�datron Survey � Hardcover Removal; 'Septic � �N'a�er Connect��n <br /> � Foundation Water�roofing � Other(specify) �irepiace , ; ' � Sew�r ConneCtioti <br /> framing -C7 Masonry . �] LaWn arrigaiiott <br /> lnsulation �,Mfg. t7 �andscaping <br /> s-Buiit Survey Y] ath�r{speci�) . <br /> � Fi�l , <br /> l.athe Rsquired S#ate 1�erniits <br /> 17 tjtt�er(specify) <br /> �Neil Flectricat <br /> R�MARKS(in-house); � <br /> OFFICIAl.R�MARKS-TO BE NOTED ON PERMIT AND ifiti'TIALLED: <br /> L] See BuElder Acknowledgement Form <br /> C! Prior to rele�se of�scrow money an as-built survey and hardcover calcu�a#ions rnus#be submitted and approved. ' <br /> Updated: October 2015 <br /> r\fnrmc\nlan ro�ria�w rh�artklict 1(1_7(Y1�i rinrtv <br />