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Qverage Lakeshore Setback B�u,� <br /> Shoreland District NfC�'ND Permit Met? <br /> � Yes C3 <br /> 0 Yes O No Permit Number: L3 Yes t� No � N/A No <br /> CI N/A-see attached Setback; <br /> StormwaterQuatit�r Existing Prop�sed <br /> Overtay District Tier Hardcov�r Hardcover Variance Required CUP Requir�d <br /> circle one %and s %and s <br /> C! Yes Q No fl Yes � No <br /> � 2 a 4 5 Tme(S): T�e(s): <br /> Fees to be Char ed ': Yf� NO <br /> �Pe�tt ; ' ' ' <br /> Plan Rev;ievd � <br /> Sta�Suraharge . . _ . �"' <br /> lnvestigation Fee <br /> SAG�-Nur�ber of SAC tlnits ' <br /> Other(specify) t/' <br /> S �arg Foota e $ er S uare�oota e <br /> Bas�ment X = $ <br /> 1�F1oor X : = $ <br /> Z�Floor X ' - $ <br /> Garage X - $ <br /> Estimated Construction Value: g <br /> Orono Insp$�tions Required Work Requiring Separate Pe�mits <br /> � <br /> ❑ Footing Q Site C] Piumbing � Gradinglfilling <br /> 0 Poured Wall � Silt FencelErosion Control C! Mechaniaal t] fire <br /> p Foundation Survey: . � Hardcover Remova! � Septic � Water Cor�nection <br /> 0 oundation Waterproofing O,Other(specify) C! Firepiace D Sewer Connection <br /> Framing ' - a Masonry � L�wn lrrigation <br /> t1 insuiation �' Mfig. � Landscaping <br /> � as-Bui1t Survey t3 Other(specify) <br /> Finat , <br /> C] Lathe ' Required State Permits <br /> ❑ Othe�{specify) ; <br /> _ ❑ Well Elect�ical <br /> RfMARKS.(in-house): ; <br /> OEf1ClAL REMARKS-TO B.E NOTED 0[� PERMlT AialD INiT{A�LED: <br /> � See Builder Acknowiedgement Form <br /> Q Prior to release ofi escrow money an as-bui�t survey and hardcover calculations must be submitfed and approved. <br /> Updated: October 2015 <br /> ' r\fnrmc\nlan raviow rhorlrlicl 1(1_9(11�i�Inrv . . <br />