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Average Lakeshore Setback Bluff <br /> Shoreland District H C1ND Permit ? <br /> 13 Yes <br /> Permit Number: a Yes No a N/A No <br /> Yes 13 No Setback: <br /> a N/A-see attached <br /> Stormwater Quality Existing Proposed <br /> Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> (Circle one) (%o and sf) %and f) <br /> tii'SI Yes a No 13 Yes <br /> 1 2 3 4 5 13.01S wr 6 TvDefsy 9 12j Type(s): <br /> 0-15`s 34' 341! 513 <br /> Fees to be Charged YES NO <br /> Rerrnit <br /> Plan Review 1/' <br /> State Surcharge be"— <br /> Investigation Fee <br /> SAC-'Mumbler of SAC Units <br /> Other(specify) <br /> Square Footage $per Square Footage <br /> Basement X = $ <br /> 14floor X 4 <br /> 2"d Floor X $ <br /> Garage <br /> X <br /> Estimated Construction Value: $ 41-7 0 <br /> Orono Inspections Required Work Requiring separate P�1 <br /> Footing ® e E Plumbing 1T Grading; /Filling <br /> a Poured Wall Silt Fence/Erosion Control a Mechanical a Fire <br /> a Foundation Survey a ardcover Removal i 0 Septic; 'a Water Connection <br /> [] Foundation Waterproofing 0 Other(specify) 13 Fireplace Cl Sewer Connection <br /> DFraming a Masonry a Lawn irrigation <br /> insulation a Mfg. Cl Landscaping <br /> OT4s-Buiit Survey Lt Other(specify) <br /> Final <br /> a Lathe ,p Required State Permits <br /> Other(specify) !1 t /11 Wall' Mid c l <br /> / Pi S ,ec l' 4. 0 Weil Electrical <br /> REMARKS(in-house): PM"i - pt Res d.+ --ras I1 ‘0.681- 19t.4t15, SIfitgr re V1 <br /> ePti <br /> SVIO t# Lif. rte oto riot e4w o4 tQiSai 11611''2-p telt.14-- <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> )(See Builder Acknowledgement Form <br /> 13 Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> 7.1fr rrn r lan raviawr rharklict in-9(11F rinrr <br />