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l�vera��[.akeshcre Sethack BIuf4' <br /> a6�orefa�d �istc6e� ���� �Q�i� �6e$? <br /> Permit Number: � Yes � No p �/q � Yes C� <br /> � Yes � No �O <br /> � N/A-see attached Setback: <br /> Storm��te�C�uafity F 4stin� Propased <br /> OverEay�6strEct�'�er I�ardccver liae�c�ver �arianae Required C�il�Rec�uired <br /> circle one %and sf %and s <br /> Q Yes � No Q Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> fees to be Char ed Y�S �Q <br /> �'�� <br /> Pian Review '�' <br /> St�da�ure�a�r�e t�' <br /> Investigation �ee <br /> S�-i+tum�er.of S�4��n�s � '�' <br /> Other(specif�) � <br /> S uare Foota e E r S uare Foo e <br /> Basement X ' � <br /> 1�Floor X ' $ <br /> 2"� Floor X - $ <br /> Garage X - $ <br /> Estimatec! Construction Value: � �!'-/�� � <br /> Orono la�spections Rec�uired Work Reqwiring 5eparate Pern�oits <br /> � ���ng 47 Site Plumbing � Grading/Fill'rng <br /> C! Poured Wall 1] Silt Fence/Erosion Contral echanical � fire <br /> � founclation Survey i� Hardcover Removal d Septic � Water Connection <br /> O �oundation Waterproofing 0 Other(specifyj fl Fireplace fl Sewer Connection <br /> �raming O Masonry O Lawn irrigatlon <br /> Insulation 0 Mfg. i] Landscaping <br /> � As-Built Survey � Ott�er(specify) <br /> final <br /> Q Lathe Rsqufrsd State Permits <br /> � Other(specify} <br /> i3 Well ' Electrical <br /> REMARKS(in-house): <br /> OFFlCiAL RE�JiJ4RRKS-Tt3 BE NOTED 0t� PERFe��EE'At�D lt�ITEA�LED: <br /> � See�uildec�cknc�iedgement For� <br /> E� Prior to rele�e of escrow money an as-built survey and hacdcover calculations must be submitted and approved. <br /> �-�� <br /> e � �� <br /> �� <br /> Updated: October 2015 <br /> �•lfnrmc\nlan rraviow rthorklict't(1_9(11.ri rinrtv <br />