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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> Permit Number: � Yes 0 No � N/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 °/o and sf <br /> � Yes � No 0 Yes � 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 l.� <br /> SAC— Number of SAC Units �� <br /> Other(specify) <br /> Square Foota e $ per Square Footage <br /> Basement X = $ '' <br /> 1 S� Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ / oi ��o <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site ❑ Plumbing ❑ Grading/ Filling <br /> � Poured Wall O Silt Fence/Erosion Control 0 Mechanical � Fire <br /> ❑ Foundation Survey 0 Hardcover Removal 0 Septic � Water Connection <br /> ❑ Foundation Waterproofing ❑ Other(specify) � Fireplace � Sewer Connection <br /> Framing � Masonry ❑ Lawn Irrigation <br /> � Insulation 0 Mfg. � Landscaping <br /> 0 s-Built Survey ❑ Other(specify) <br /> inal <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 /> � See Builder Acknowledgement Form <br /> � 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 rcvio�ni rharklict 1(1_9(11F rinrv <br />