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Shoreland District MCWD Permit Average Lakeshore Setback Bluff � <br /> Met? <br /> Permit Number: 0 Yes 0 No 0 N/A 0 Yes � <br /> � Yes 0 No No <br /> 0 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 0 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 <br /> SAC— Number of SAC Units <br /> Other(specify) <br /> Square Footage $ per Square Foota e <br /> Basement X = $ <br /> 151 Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �LJi� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing � Site � Plumbing 0 Grading/Filling <br /> ❑ Poured Wall ❑ Silt Fence/Erosion Control � Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal � Septic 0 Water Connection <br /> 0 Foundation Waterproofing 0 Other(specify) ❑ Fireplace 0 Sewer Connection <br /> Framing ❑ Masonry � Lawn Irrigation <br /> 0 Insulation 0 Mfg. ❑ Landscaping <br /> � As-Built Survey � Other(specify) <br /> �Final <br /> 0 Lathe Required State Permits <br /> 0 Other(specify) <br /> ❑ Well � Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> 0 See Builder Acknowledgement Form <br /> 0 Prior to release of escrow money an as-built surve,y and hardcover calculations must be submitted and approved. <br /> C�a !1 � vl s� �e i� r` �y! �'�;����;%� � ��� ����- <br /> � ��1 �r � �' [�Gt�P� <br /> �_z <br /> Updated: October 2015 <br /> ��\fnrmc\nlan rovia�ni rharklic4 1 fl_'7f11 ri rinrv <br />