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Average Lakeshore Setback <br /> Shoreland District MCWD Permit Met? � Bluff <br /> . <br /> 0 Yes 0 No Permit Number: 0 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 /> 0 Yes � No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Perm it <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 /> 1 S' Floor X = $ <br /> 2nd FloOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: � <br /> � p <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 /> 0 Foundation Survey � Hardcover Removal � Septic � Water Connection <br /> ❑ Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> Framing � Masonry 0 Lawn Irrigation <br /> Insulation 0 Mfg. � Landscaping <br /> 0 As-Built Survey � Other(specify) <br /> Final <br /> 0 Lathe Required State Permits <br /> 0 Other(specify) <br /> 0 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 survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �•\fnrmc\nlan ravia�ei rha�lrlic}1(1_9(11F rinrv <br />