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Av�rag�L�keshcre S�tE�acPe �f�� <br /> Shore6ancf Qistrict ���'� ���'��� I�et? <br /> � Permit Number: � Yes �No � �/q � Yes <br /> � Yes � No No <br /> s � N/A-see attached ��-� Setback: <br /> Stormwater QualitZ+ Existing �roposec6 <br /> Overtay Disfrict Tier Hardcovee Ffardcover Variance Rec�c�ired CUP Requtred <br /> circle one %and sf %and s <br /> �(}�� �t��p� Yes � No C] Yes No <br /> 1�, 2 3 4 5 ���� � y^ ����� T e s): Type(s): <br /> '�.d Sl <br /> � .��� ����°o ���� s� z�..��?� 3cx�i � <br /> Fees to be Cha ed YES NO <br /> PermE� <br /> Rlan Re�iew <br /> �#at�Surci�arge <br /> Investigation Fee <br /> SAC-Humber of SAC Units <br /> Other(specify) <br /> S uare Foota e � er S uare�oota e <br /> Basement X - � <br /> 1�Fioor X ' $ <br /> 2nd Floor X = $ <br /> Garage X - $ <br /> Estimated Construction Value: S <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing Q Site � Piumbing � Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Contrpl p Mechanical a Fire <br /> �Foundation Survey C! Hardcover Removal O Septic � Water Connection <br /> Foundation Waterproofing � Other(specify) � Fireplace O Sewer Connection <br /> 0 Framing 0 Masonry � Lawn Irrigation <br /> � Insulation � Mfg. � Landscaping <br /> �s-6uilt Survey �3 Other(specify) <br /> f� Final <br /> t� �athe Requirec!Stat�Permits <br /> Cf Oth�r(specify) <br /> 0 Wetl E� Electricai <br /> REMARKS(ir�-housef. <br /> O�FICtAL REC�GARFC�-�'Q BE �!O'6ED Ot� PERi1�ET/•lt�D II�iTfALLED: <br /> '��ee�u6lder eR.ckno�v4edgemer�t Forr� <br /> �rior to oney an as-built su cover calculations mu d• <br /> Updated: October 2015 <br /> v\fnrmclnlan ra�iioui nc�rklict 1l�9R'I F rinrr <br />