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_ r <br /> � <br /> Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> 0 Yes 0 No Permit Number: 0 Yes � No 0 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 /> � Yes � No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Perm it l/ <br /> Plan Review (/' <br /> State Surcharge V— <br /> Investigation Fee (�' <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 FlOor X = $ <br /> Garage X = $ <br /> f <br /> Estimated Construction Value: $ �,� <br /> v <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing 0 Site � Plumbing 0 Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control Mechanical 0 Fire <br /> � Foundation Survey � Hardcover Removal � Septic 0 Water Connection <br /> 0 Foundation Waterproofing � Other(specify) 0 Fireplace ❑ Sewer Connection <br /> Framing 0 Masonry � Lawn Irrigation <br /> 0 Insulation 0 Mfg. � Landscaping <br /> � As-Built Survey 0 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 /> r\fnrmc\nlan ravic�ei rharklict'I fl_9(11 F rinrv <br />