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.��.�`� r <br /> Shoreland District MCWD Permit n� Average Lakeshore Setback Bluff � <br /> ��' Met? <br /> � Yes �No Permit Number: 1�.�� � Yes � No N/A � Ye No <br /> 0 N/A—see attached Setback: <br /> Stormwater Quality Existing Proposed � <br /> Overlay District Tie�r Hardcover Hardcover Variance Required CUP Required <br /> circle one % and s (% and sf <br /> � � Yes No � Yes No <br /> 1 2 3 4 � Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit <br /> P6an Review //' <br /> �1ta#e Surcharge 1/' <br /> Investigation Fee <br /> SAC—Number of SAC Units I/' <br /> Other(specify) <br /> S uare Foota e $ er Square Foota e <br /> Basement X = $ <br /> 1S' Floor X = $ <br /> 2nd FIoO� X = $ <br /> Garage X = $ <br /> Estimated Constructioru Value: $ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �,Fo�ting 0 Site Plumbing ❑ Grading/Filling <br /> Poured Wall Silt Fence/Erosion Control Mechanical � Fire <br /> Foundation Survey 0 Hardcover Removal 0 Septic �Water Connection <br /> Foundation Waterproofing 0 Other(specify) Fireplace �Sewer Connection <br /> �i Framing � Masonry � Lawn Irrigation <br /> �Insulation �Mfg. � Landscaping <br /> As-Built Survey � Other(specify) <br /> Final <br /> Lathe Required State Permits <br /> �[ Other(specify) f `� DUr, <br /> � � � � Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> �See Builder�Acknowledgement Forrr� <br /> �, an as-built surve <br /> Updated: October 2015 <br /> r\fnrmc\nlan rovio�ni rhorklic4 1 fl_9(11 F rinrv <br />