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Shoreland District MCWD Permit Average Lakeshore Setback gl�ff <br /> Met? <br /> Yes 0 No Permit Number: 0 Yes 0 No N/A � Ye No � , <br /> , <br /> N/A—see attached Setback: <br /> Stormwater Quality Existing Proposed <br /> Overlay District Tier Hardcover Hardcove Variance Require CUP Required <br /> circle one % and sf % and sf <br /> ?�•C�b02'0 3 2•�C�O�b � Yes No � Yes No <br /> �1 2 3 4 5 ��c��� 3o�s� Type(s): Type(s): <br /> J <br /> Fees to be Char ed YES NO <br /> Permit t/� <br /> Plan Review <br /> State Surcharge 'U <br /> Investigation Fee <br /> SAC— Number of SAC Units v <br /> Other(specify) <br /> Square Footage $ per Square Footage � <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FIOOr X = $ <br /> ' Garage X = $ <br /> Estimated Construction Value: ���(/ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site � Plumbing � Grading/Filling <br /> 0 Poured Wall ❑ Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> � � Foundation Survey 0 Hardcover Removal 0 Septic ❑ Water Connection <br /> ❑ Foundation Waterproofing � Other(specify) ❑ Fireplace ❑ Sewer Connection <br /> Framing 0 Masonry 0 Lawn Irrigation � <br /> ❑ Insulation O Mfg. � Landscaping <br /> � As-Built Survey � Other(specify) <br /> Final <br /> � Lathe Required State Permits <br /> ❑ Other(specify) <br /> 0 Well � Electrical <br /> � / <br /> REMARKS (in-house):��5d�(,��(,�V� (�.,��;ii"��,1�'j'� «�J Sf �}1 Z�•��� �� ..J�l'�,tG�U�GL,<--� <br /> �c�,i�,�-U,-�t�a., � — <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> �See Builder Acknowledgement Form <br /> �Prie�to release of escrQw_money a�r as-6ulf-surve�-and hardcove�al� � ust be sub ' d. <br /> Updated: October 2015 <br /> �•\fnrmc\nlan ravio�ei rhorklict 1f1_9(11F`inrv <br />