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Shoreland District MCWD Permit Average Lakeshore Setback Blu�f <br /> Met? • <br /> 0 Yes 0 No Permit Number: 0 Yes 0 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 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 V <br /> State Surcharge (/' <br /> �e'� . . <br /> Investigation Fee <br /> �I r �- `�` � SAC— Number of SAC Units �/' <br /> ' ���� Other(specify) '(/� <br /> -�`��``'��- ��I 1� <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> .� <br /> Estimated Construction Value: $ 2�, ��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing � Site � Plumbing � Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control � Mechanical � Fire <br /> 0 Foundation Survey � Hardcover Removal 0 Septic 0 Water Connection <br /> 0 Foundation Waterproofing 0 Other(specify) � Fireplace � Sewer Connection <br /> Framing � Masonry � Lawn Irrigation <br /> Insulation � Mfg. � Landscaping <br /> � As-Built Survey 0 Other(specify) <br /> Final <br /> � 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 /> � 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 /> �•\fnrme\nlan ravia�ei nc�rklict 1f1_9(11F rinrv <br />