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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Yes � No Permit Number: 0 Yes � No N/A � Ye Na- <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 /> � 20���fD ZQ,Q�!D � Yes No � Yes No ' <br /> 1 2 � 3 f 4 5 j_,',. '" Type(s): Type(s): <br /> �/ �Q.� .S 1 U i „ , <br /> i-' i <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) � <br /> �: <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 'i 1 St Floor X = $ <br /> 2"d Floo� X = $ ,_ <br /> Garage X = $ <br /> rr d <br /> Estimated Construction Value: $ �,��Q <br /> - l <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing 0 Site � Plumbing � Grading/ Filling <br /> � Poured Wall � Silt Fence/Erosion Control 0 Mechanical � Fire <br /> ❑ Foundation Survey � Hardcover Removal 0 Septic 0 Water Connection <br /> 0 Foundation Waterproofing ❑ Other(specify) 0 Fireplace � Sewer Connection <br /> �Framing � Masonry � Lawn Irrigation <br /> 0 Insulation � Mfg. ❑ Landscaping � <br /> � As-Built Survey 0 Other(specify) <br /> Final <br /> ❑ Lathe Required State Permits <br /> ❑ Other(specify) <br /> 0 Well ❑ Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> See Bu' e knowledgem o <br /> Pri to release of e money an as-bui survey and h over alculatio ust ubmitte ve . <br /> Q lS Y V`c- l � �l'0�-� <br /> . �Sc,l'oh/ ��i t <br /> � �u cA �ar'-- Ob W�- O�.ba�e. <br /> Updated: October 2015 <br /> �•\fnrmc\nlan ravia�ni rhor41ic4 1(1_9(11�i rinnv <br />