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�Q�t��,L�:Q 1 V <br /> Shoretanc6 Distrtcf h�Cl�`Q� �ermif �eerage Lake�hore�etback ,�{� <br /> tl�et? <br /> � Permi#Number: � � Yes Q No � N/A � Yes <br /> A Yes E� No �O <br /> I� N/A—see attached Setback: <br /> �tormwater t�uality Existing Proposed <br /> C3verlay Di�tricfi Tier Harcfcover Hardcover Variance Requfred CUP Req�ireci <br /> circle one %and s %and s <br /> �,, — , �✓ :� k� i� Yes t�� No � Yes �Q No <br /> 1 2 3 4 5 �¢r, , ,f� a . �yPe(S)� ' � Type(s): . <br /> I �".i � _ E . , i <br /> Fees to be Char ed YES . . NO <br /> Permit <br /> Rian Review <br /> State Surcfiarge <br /> Investigaticn�e� <br /> SAC—Nurr�i�er�f SAC�l�its <br /> Other(specify) <br /> S uare Foota e � er S uare focta e <br /> Basement X = $ <br /> 15f Floor X _ � : <br /> 2"d F�OOT X _ . $ <br /> Garage X = $ <br /> Estimatec4 Construct�on 1/alue: � t%U-� <br /> Orono inspections Requtred Work`Rec#uiring Separate Permits <br /> �ooting � Site ' Plurnbing t3 Grading/Filling <br /> 1� Poured Wall B Silt Fence/Erosion Control echanical Q Fire <br /> t7 Foundation Survey � Hardcoyer Removal O Se}�tic � �7i 1Nater Connection <br /> Ci Foundation 41Vaterproofing � Other(specify) �1 Fireplace iJ Sewer Cor�nection <br /> � �raming � O Masonry � Lawn lrrigation ' <br /> t1 Insulation � Mfg. � Lands�apSng <br /> As-Bui[t Sunrey D Other(spec9fyj <br /> Final <br /> Q Lathe Required Sfate Pe�mits <br /> � Other{specify) <br /> 0 Weli Etectrical <br /> REMARKS(in-hoase): <br /> O FIClAL REtJiARKS-TO BE t�OTE�Ot� PERNiiT AND IfilITI�LLED: <br /> ��e Builcier Ackno�rtec#gern�nfi Fortn <br /> B'f�Prior to rele scrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> ..... ._____.....--"`"".._ ..._ _._-- --_. _ _ _.... �r_____._..___ ......__. <br /> _..._. '—�-�—•, -�---._ _ ..__._ _ <br /> _ �...---- <br /> Updated: October 2015 <br /> �•\fnrmc\nlan roviaw rhPrklicf 1!1_9(19.ri rinrY <br />