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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> t Permit Number: 0 Yes � No � N/A � Yes 0 <br /> 0 Yes � No 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 /> O 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 l/' <br /> Plan Review �/' <br /> State Surcharge ti <br /> Investigation Fee � <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Foota e $ per S uare Foota e <br /> Basement X = $ <br /> 15�Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> o� <br /> Estimated Construction Value: $ �, �Q <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site �Plumbing 0 Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control �Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal � Septic � Water Connection <br /> � Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> Framing O Masonry � Lawn Irrigation <br /> Insulation � Mfg. � Landscaping <br /> � As-Built Survey 0 Other(specify) <br /> Final <br /> � Lathe Required State Permits <br /> 0 Other(specify) <br /> 0 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 ravio�ni rharklic4 1(1_7f1'IF rinrv <br />