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Shoreland District MCWD Permit Average Lakeshore Setback Bluff ` <br /> Met? � ` <br /> � Yes No Permit Number: f(o _ 1 S� � Yes 0 No N/A � Yes . <br /> � No �� <br /> � N/A-see attached Setback: <br /> Stormwater G3uality Existing Proposed <br /> Overlay District Tier Hardcover Hardcover Varian�e Required CUP Required <br /> circle one % and sf % and sf <br /> � Yes No 0 Yes No ° <br /> 1 2 3 4 _._�.___ _ --s- TYPe�S). Type(s). <br /> Fees to be Char ed YES NO <br /> Permit (/' <br /> Plan Review l/ <br /> State Surcharge (i^ <br /> Investigation Fee [/' <br /> SAC-Number of SAC Units <br /> Other(specify) <br /> Square Foota e $ er Square Foota e <br /> Basement X - $ <br /> 1St Floor X - $ <br /> 2nd FIOOr X = $ <br /> Garage X = $ <br /> � �� c�/ -�� <br /> Estimated Construction Value: $ � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing ❑ Site Plumbing � Grading/Filling <br /> Poured Wall Silt Fence/Erosion Control Mechanical � Fire <br /> Foundation Survey � Hardcover Removal 0 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) / ho�,� �►a �Cs <br /> ❑ Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> �See Builde Acknowledgement Form <br /> ior t as of escro - uilt survey and har er ca cu i e and approved. <br /> Updated: October 2015 <br /> �•\fnrmc\nlnn rovip�ni rharklic4 1(1_9M F Anrv <br />