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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> M et? <br /> Permit Number: � Yes 0 No 0 N/A � Yes 0 <br /> 0 Yes � No No _ <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 sf <br /> � Yes 0 No � Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plan Review <br /> State Surcharge �/�' <br /> Investigation Fee � <br /> SAC–Number of SAC Units <br /> Other(specify) 1/— <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 15t Floor X = $ <br /> 2nd Floo►' X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ 7(�R ()��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing � Site Plumbing � Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control ,�L Mechanical � Fire <br /> ❑ Foundation Survey � Hardcover Removal �❑ Septic 0 Water Connection <br /> 0 Foundation Waterproofing � Other(specify) ireplace ❑ Sewer Connection <br /> Framing � Masonry 0 Lawn Irrigation <br /> Insulation ❑ Mfg. ❑ Landscaping <br /> ❑ As-Built Survey 0 Other(specify) <br /> �Final <br /> ❑ Lathe Required State Permits <br /> � Other(specify) <br /> ❑ Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> ❑ See Builder Acknowledgement Form <br /> � Prior to release of escrow mo ey an as-built survey and hardcover calculations must be submitted and approved. <br /> !�/ !� �`Z <br /> Updated: October 2015 <br /> �•\fnrmc\nlan rcvio�ei rharklicT 9(1_9f1'15 rinrv <br />