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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> M et? <br /> Permit Number: � Yes ❑ No 0 N/A 0 Yes � <br /> ❑ 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 /> 0 Yes � No � Yes 0 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) � <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X = $ <br /> ; <br /> Garage X = $ <br /> � <br /> Estimated Construction Value: $ ���� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> _ 0 Footing 0 Site ❑ Plumbing 0 Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> ❑ Foundation Survey 0 Hardcover Removal ❑ Septic � Water Connection <br /> Foundation Waterproofing ❑ Other(specify) ❑ Fireplace � Sewer Connection <br /> Framing ❑ Masonry O Lawn Irrigation <br /> � Insulation 0 Mfg. ❑ Landscaping <br /> 0 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 /> 0 See Builder Acknowledgement Form <br /> 0 Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �•\fnrmc\nlan rcvia�ni rharlrlic#1 fl_9f11 F rVnrv <br />