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Shoreland District MCWD Permit Average Lakeshore Setback Bluff . <br /> M et? <br /> 0 Yes � No Permit Number: � Yes 0 No 0 N/A � Ye 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 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plan Review <br /> State Surcharge <br /> Investigation Fee <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 Floot' X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ ��D�D � <br /> � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site 0 Plumbing 0 Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control ❑ Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic 0 Water Connection <br /> � Foundation Waterproofing � Other(specify) 0 Fireplace 0 Sewer Connection <br /> Framing ❑ Masonry � Lawn Irrigation <br /> � Insulation 0 Mfg. 0 Landscaping <br /> � As-Built Survey 0 Other(specify) <br /> Final <br /> 0 Lathe Required State Permits <br /> � Other(specify) <br /> � Well 0 Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> 0 See Builder Acknowledgement Form <br /> � Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> !'�r a�I �l� `�' �l :'�OI � ����i 72r �vr�t e -�'c� c� �Li r� �v'.9i1 i <br /> i^�d�! � n l� <br /> Updated: October 2015 <br /> �•\fnrmc\nlan ravia�u rhorklict 1(1_9f11F rinrv <br />