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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? • <br /> 0 Yes 0 No Permit Number: 0 Yes 0 No 0 N/A � Ye No � <br /> O 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 Q No ❑ Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit � <br /> Plan Review l/ <br /> State Surcharge <br /> Investigation Fee {f <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 X = $ <br /> �/ /�� <br /> Estimated Construction Value: $ `7�, ��(l <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing � Site Plumbing � Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control Mechanical 0 Fire <br /> � Foundation Survey 0 Hardcover Removal 0 Septic � Water Connection <br /> � Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> �Framing ❑ Masonry 0 Lawn Irrigation <br /> �q,Insulation � Mfg. 0 Landscaping <br /> 0 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 money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �•\fnrmc\nlan fP\/IPU/rharklicf'I(1_7(11F rinrv <br />