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Shoreland District MCWD Permit �J�� Average Lakeshore Setback gFuff <br /> M et? <br /> Ir _ �� 2 � Yes <br /> � Yes No Permit Number: J w � Yes 0 No N/A No <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 sf <br /> /� � Yes No � Yes No <br /> 1 2 3 4 �5 ► �� Type(s): Type(s): <br /> U <br /> Fees to be Charged YES NO <br /> Permit l/� <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 /> 1 S� Floor X = $ <br /> 2nd FIOo� X = $ <br /> Garage �j`�d X 3c�.J� - � 32 3 � �� <br /> Estimated Construction Value: $ �� , ��D <br /> � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site � Plumbing ❑ Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> � Foundation Survey ❑ Hardcover Removal ❑ Septic � Water Connection <br /> � Foundation Waterproofing 0 Other(specify) ❑ Fireplace � Sewer Connection <br /> Framing ❑ Masonry � Lawn Irrigation <br /> � Insulation � Mfg. ❑ Landscaping <br /> As-Built Survey � 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 /> � Pnor escrow mo - urvey and h ations must n approved. <br /> Updated: October 2015 <br /> �'\fnrmc\nlan rovia�ni rharklict 1 fl_9M�i rinrv <br />