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Shoreland District MCWD Permit Average Lakeshore Setback Bluff � <br /> Met? <br /> 0 Yes � No Permit Number: 0 Yes 0 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 � 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 t� <br /> Investigation Fee w <br /> SAC—Number of SAC Units 1i- <br /> Other(specify) v <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FIOo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �V, ��� � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing � Site � Plumbing ❑ Grading/Filling <br /> ❑ Poured Wall 0 Silt Fence/Erosion Control � Mechanical 0 Fire <br /> 0 Foundation Survey ❑ Hardcover Removal � Septic ❑ Water Connection <br /> � Foundation Waterproofing 0 Other(specify) � Fireplace 0 Sewer Connection <br /> Framing � Masonry � Lawn Irrigation <br /> 0 Insulation � Mfg. � Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> Final <br /> � Lathe Required State Permits <br /> 0 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 /> � 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 ravic�u rharklich'I fl_9f19 F rinrv <br />