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� - <br /> � " -: ; ' <br /> f Shoreland Distric�t NOGVi(D P�rmit Averag�L��S�sC�or�,Setback BlufF <br /> MetB <br /> � Permit Number. � Yes �]'I�a L] Mf�i+�► O Yes IC� <br /> ! � � Y�s � No ; `No <br /> C] N/A-see attach�d Setback: <br /> � � Pro seei , <br /> Stormwat�r Qw�l�y F�c�stin� po <br /> �. t�v�rla�D'rstcFct Tier Har�cover- � liat�dcouer Vgriance Req�aired - CUP R�Quir�d . <br /> c�rGe one %and s °�a and"s : . <br /> �'; Q Yes L7 No W Yes C7 No : <br /> � � � � '�, � '�Yp��sj� TY�(S�� <br /> , <br /> . , _ _ Fees to 6�Cfi�r ed YES� �O ,.. <br /> � ' : _ = , , <br /> , � P�mit���: � , � �,.�.-� , . <br /> � Pl�r� R��aiew . <br /> � Stat�S�rcharg� : <br /> ! Inwesfi�gation Fe� <br /> , <br /> -. <br /> E ���—�1urr�bBr t�fi SAC`Un� t,r�'" ` - <br /> ,., <br /> �her(s�e�fify) 'l,r/' <br /> '� , . � <br /> S �aare F�ota`� � r S uars Fot�fa <br /> ' Basement , , � ' _ � <br /> � ?�Floor � :� <br /> 2� Floor � . . } : X = $ <br /> II G�rage X $ � <br /> k:� .; <br /> �stimatee�Con�truct�ora Yalue: � - � <br /> Orano I;nspectians Requirte�l UVo,rk Requicing Separate Permits <br /> f; ; <br /> � �'ooting � Site 'O Plumbing . [] Grading/Filfing <br /> ' � Poured Wall ` � Silt��rtce��rosipn Cont�ol � Mect�anicai` D Fire <br /> 0 FoundafYo�Su�vey . � Hardcover'Removal s C] Septic � Water Connec�on % <br /> �� `` � ��� :,; <br /> �� �Foundafion Waterproofing ' � OChe��specify) ; � Firepiace � Sewer Conne�fion <br /> � framing` ` 1�1 Masonry � Lawn Irrigatid�► <br /> � O lnsulation ° � :Nffg. fl Landscap�ng <br /> C'�,�►��u�l�'�urvey [� OtMer(specifY} � <br /> �i��� _ � <br /> �' � the R�quired State Permits � <br /> 0 O'kh�r(specify} ; � � <br /> I <br /> � W�II � Electrical <br /> l2EMARKS �in-haiise}:` . � <br /> I � ;OFF#CIA�REMIARKS-1`0�E W�TED OI�,.PERMIT A�19D INITIALLE[3: - <br /> i :� S�e Builder Ackno�nvl�dg��r�t Fe�rm <br /> ' � Prlor to rel��se of es�row money an as�buiit survey and hardcover calcu#ations,must be submitted and ap�roved:, �, <br /> j <br /> � Updated: October 2015: . � ; <br /> I. rifnrmcWan roviow r.hrsrklfc4 111.2f11+",Anrv' � , <br />