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Average Lakeshore Setback <br /> Shoreland District MClVD Permit Met? Bluff <br /> Slp4„.X <br /> Yes 0 No Permit Number: es 0 No 0N/A 0 Yes, Np ''' <br /> 0 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 d sfl <br /> 1 2 3 4 6 <br /> -7' 5 3 0 0 LP' 8 3 ilp 0 Yes No 0 Yes .Vt., <br /> - (s): ' Type(s): <br /> e(s): <br /> LO y1/05Sf` 61°/ `5 <br /> Fees to be Charged YES, NO <br /> Permit y , <br /> Plan Review <br /> State Surcharge <br /> Investigation Fee <br /> SAC -.'Number of SAC Units <br /> Other(specify) <br /> Square Footage $per Square Footage = <br /> Basement X = <br /> ltd Floor X = :$ <br /> 2nd Ploor X <br /> Garage X _ $ <br /> Estimated Construction Value: $ I) i• <br /> 0o02 <br /> Orono inspections Required Work Requiring Separate Permits <br /> )Footing Cl Site Plumbing $3 racliingJFilling <br /> ' <br /> Poured Wall; Silt i+ e�nical e:; <br /> Fence/Erosion Control � I � `� ' :, , <br /> Foundatior1 Survey Cl Hardcover Removal fl S eptic rU W er C e tlipn <br /> Fo iridation Waterproofing tl. Other(specify) - rrePace ,Stir Connection <br /> Framing ZI Masonry 0 `Ie rn iliigauon <br /> lrtsulallon Mfg C °riisc, irig " " <br /> A <br /> s-Bunt Survey. ' aer( cify)" th, t. <br /> Final a <br /> %lathe; 3llequir d State Permits <br /> a:-other(specify) . , ox - :,. , <br /> WeH )(t..trical <br /> REMARK (mhouse) . '' -+ ..r" �� v ."/ iji °. _ " ,. •' <br /> OFFICIAL:REMARKS-TO BE NOTED ON PERMIT AND INITIALLED <br /> See Builder Acknowledgement Form <br /> e of escrow mo - - . -. dcover calculations m 8- submitted . ,. : .. . <br /> Updated: October 2015 <br /> ,•\fnrmc\nlan rpvipui rhor•4Iic4 I fl-XI1 c Anry <br />