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. � <br /> Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 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 /> 0 Yes 0 No � Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plan Review ✓ <br /> State Surcharge V <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 /> 2"d Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing 0 Site �Plumbing 0 Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control Mechanical � Fire <br /> ❑ Foundation Survey 0 Hardcover Removal � Septic 0 Water Connection <br /> � Foundation Waterproofing � Other(specify) � Fireplace 0 Sewer Connection <br /> Framing � Masonry 0 Lawn Irrigation <br />, Insulation � Mfg. � Landscaping <br /> � As-Built Survey � Other(specify) <br /> �Final <br /> 0 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 /> 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 ravie�ei rharlrlief 1f1_9(11F rinrv <br />