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Average Lakeshore Setback <br /> Shoreland District MCWD Permit Me#? Bluff <br /> Permit Number: � ' -t ® Yes Q No N/A O Yes <br /> ® Yes XNo ) , No y� <br /> ® N/A-see attached Setback: <br /> Stormwater Quality Existing Proposed <br /> Overlay'District Tier Hardcover Hardcover Variance Required CUP Required <br /> (circle one) (%°and sf) (%and:5fl <br /> 17 Type(s)Yes * UYes No <br /> 2 4 ""_„' 7 ype(s); <br /> Fees to be Charged 'e NO <br /> Plan Review <br /> Sclrarge '" .. <br /> investigation Fee <br /> SAC-Number of SAC Units <br /> Other(specify) 1.....,, <br /> Square Footage <br /> - $'1per Square,foota e <br /> Basement X - > .� <br /> a .5,,.. . <br /> ist Floor X _ . <br /> Vid Floor X <br /> Garage X = $ } <br /> Estimated.Construction Value: ' ► <br /> Oros, ,f,. . <br /> no:inspections Required work Requiring Separ> 0,... is <br /> Footing E Site filtanbi !C `Grading/l dtirrg <br /> Poured Wall Silt Fence/Erosion Control Mechanical D firs <br /> Foundation Survey D Hardcover Removal Septa 9 f el :. onrl ton <br /> a <br /> Foundation!plate Waterproofing 0 Other(specify) Fireplace SewerQortpia #ton '' <br /> framing ,-, ,- y a Lawry l pn, <br /> Insulation , 11 g 0 Landscaping <br /> As-Built Survey Other(sp fy) <br /> At. <br /> Final <br /> 0 'Lathe Required State Permits " ` <br /> O Other(specify) <br /> Wall nit , <br /> Electrical <br /> REMARKS.{i u°s P P�'im�4, 1 LuI sI 't..8 `,'/ yet v t. i <br /> OFFICIAL REMARKS TO BE NOTED ON PERMIT AND INITIALLED:' <br /> O See Build= Acknowledgement Form <br /> Prior • - - - o - .... -�u` su .o and •,:- a Ions 6' . - d. <br /> Updated: October 2015 <br /> r\fnnrna\n` n roviow rhorkkiict t(L9A4c Anrr <br />