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( <br /> .\/�� Y <br /> `V <br /> Shoreland District MCWD Permit � Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: �� - �� � Yes 0 No �/A � 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 /> � Yes No 0 Yes No <br /> 1 2 3 4 � ___ _ TYPe�S): TYpe(s): <br /> Fees to be Char ed YES NO <br /> Permit � <br /> Plan Review <br /> State Surcharge V <br /> Investigation Fee <br /> SAC-Number of SAC Units / <br /> Other(specify) <br /> Square Footage $ er Square Foota e <br /> Basement X = $ <br /> 1St Floor X = $ <br /> 2nd FIOOr X = $ <br /> Garage X = $ <br /> � <br /> Estimated Construction Value: $ ������ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �,Footing 0 Site lumbiny 0 Grading i Filling <br /> �Poured Wall ilt Fence/Erosion Control echanical � Fire <br /> �Foundation Survey 0 Hardcover Removal 0 eptic Water Connection <br /> Foundation Waterproofing 0 Other(specify) Fireplace Sewer Connection <br /> Framing � Masonry � Lawn Irrigation <br /> Insulation �fg. � Landscaping <br /> As-Built Survey Other(specify) <br /> Final <br /> Lathe �� Required State Permits <br /> ' 0 Other(specify) ! h(�U!/� Q C�.' <br /> 0 Well lectrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> � See Buiider Acknowledgement Form <br /> Pri eas o ardcover � s must be submitted and approved. <br /> Updated: October 2015 <br /> ��\fnrmc\nlan ra�iia�ni rhorklie4 1(1_9MF rinrv <br />