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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> M et? - <br /> �Yes 0 No Permit Number: ��,Yes � No 0 N/A � Ye No � <br /> 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 /> �L�-,C� �',��/�� 0 Yes �.,No 0 Yes ,No <br /> � 2 3 4 5 � i �r���, Type(s): Type(s): <br /> L �_�� <br /> Fees to be Char ed YES NO <br /> Permit �/�' <br /> Plan Review j/' <br /> State Surcharge <br /> Investigation Fee �f <br /> SAC—Number of SAC Units � <br /> Other(specify) �' <br /> Square Foota e $ per Square Footage <br /> Basement X = $ <br /> 15f Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> ,�1 � <br /> Estimated Construction Value: $ ��, (��'�� � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> +Footing � Site � Plumbing 0 Grading/Filling <br /> ` � Poured Wall 0 Silt Fence/Erosion Control � Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal � Septic 0 Water Connection <br /> � Foundation Waterproofing 0 Other(specify) � Fireplace 0 Sewer Connection <br /> Framing 0 Masonry � Lawn Irrigation <br /> 0 Insulation 0 Mfg. 0 Landscaping ' <br /> ❑ As-Built Survey 0 Other(specify) <br /> Final <br /> ❑ 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 /> Se ckno ent � � a,� <br /> . (,�1 �� <br /> � Prior to release of escrow money n�cov� approved. <br /> Updated: October 2015 <br /> ��lfnrmc\nlan rovio�ni rharklicf 1!1_9(19�i rinrv <br />