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Average Lakeshore Setback <br /> Shoreland District MCWD Permit � Met? � Bluff <br /> 0 Yes 0 No Permit Number: � Yes , �. No � N/A � Ye No � <br /> � N/A—see attached ' '� � ` � ' ' i ' � 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 O Yes 0 No <br /> 1 2 3 _,'.4 5 TYpe(S1>. , - ' 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 fj+ <br /> Other(specify) v' <br /> Square Foota e $ per Square Footage <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> 2nd FIOo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ � (y�/� � <br /> � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site � Plumbing � Grading/ Filling <br /> � Poured Wall � Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> 0 Foundation Survey ❑ Hardcover Removal � Septic 0 Water Connection <br /> � Foundation Waterproofing �Other(specify) � Fireplace 0 Sewer Connection <br /> 0 Framing J��Y ��� 0 Masonry ❑ Lawn Irrigation <br /> � Insulation ��" � 0 Mfg. � Landscaping <br /> 0 As-Built Survey � Other(specify) <br /> Final <br /> � Lathe Required State Permits <br /> � Other(specify) <br /> 0 Well 0 Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> 0 See Builder Acknowledgement Form <br /> � 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 rovia�u rhar4lic}1f1_9(11F rVnrv <br />