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Shoreland District MCWD Permit Average Lakeshore Setback Bluff ? <br /> Met? � `� <br /> � Yes O No Permit Number: � Yes � No � N/A � Ye 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 � No � Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit � <br /> Plan Review V <br /> State Surcharge t� <br /> Investigation Fee �/ <br /> SAC—Number of SAC Units <br /> Other(specify) �/' <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2"d FIOOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ /��O <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site ❑ Plumbing 0 Grading/Filling <br /> � Poured Wall ❑ Silt Fence/Erosion Control � Mechanical 0 Fire <br /> ❑ Foundation Survey 0 Hardcover Removal � Septic 0 Water Connection <br /> � Foundation Waterproofing � Other(specify) 0 Fireplace � Sewer Connection <br /> �Framing � Masonry 0 Lawn Irrigation <br /> 0 Insulation � Mfg. � Landscaping <br /> ❑ As-Built Survey 0 Other(specify) <br /> Final <br /> 0 Lathe Required State Permits <br /> ❑ Other(specify) <br /> � Well � Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> � See uild Acknowledgem�nt Form \ 'f��` <br /> � P � r to re lease`e f�s�rotiv money an as-bui l t su T v e�C.�d'�iar dcover ca lcu la tion,'s�us t b e�u l�r f ii t te d an pra u��---� <br /> Updated: October 2015 <br /> �•\fnrmc\nlan rovia�ni rharklic4 1(1_9f11 F rinrv <br />