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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 0 No No <br /> � N/A—see attached Setback: <br /> Stormwater Quality Existing Proposed <br /> Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> circie one % and sf (% and sf <br /> 0 Yes 0 No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged 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 /> 15t Floor X = $ <br /> 2�d FIoOP X = $ <br /> Garage X = $ <br /> f j� � <br /> Estimated Construction Value: $ �i l�V <br /> �� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site 0 Plumbing ❑ Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control ❑ Mechanical 0 Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic ❑ Water Connection <br /> ❑ Foundation Waterproofing � Other(specify) ❑ Fireplace ❑ Sewer Connection <br /> �Framing 0 Masonry � Lawn Irrigation <br /> Insulation � Mfg. ❑ Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> Final <br /> � 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 Builder Acknowledgement Form <br /> 0 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 ravia�ni rharklict 1(1_9(11�i rinrv <br />