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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes p No Permit Number: � Yes 0 No � 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 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Perm it <br /> Plan Review ". �'` <br /> State Surcharge l/' <br /> Investigation Fee V' <br /> SAC—Number of SAC Units (� <br /> Other(specify) �/' <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> 2nd FIOOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ � �%, �(it/ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site Plumbing � Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control Mechanical � Fire <br /> 0 Foundation Survey 0 Hardcover Removal 0 Septic ❑ Water Connection <br /> 0 Foundation Waterproofing 0 Other(specify) 0 Fireplace ❑ Sewer Connection <br /> Framing 0 Masonry 0 Lawn Irrigation <br /> Insulation 0 Mfg. ❑ Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> �Final <br /> � Lathe Required State Permits <br /> 0 Other(specify) <br /> 0 Well Electrical <br /> � <br /> c <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> � 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 ravia�ni rharklict 1(1_7(115 rinrr <br />