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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes 0 No Permit Number: � 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 /> � Yes � No 0 Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit �/ <br /> Plan Review j/'� <br /> State Surcharge �j— <br /> Investigation Fee i/ <br /> SAC—Number of SAC Units '� <br /> Other(specify) � <br /> Square Foota e $ per Square Footage <br /> Basement X = $ <br /> 15i Floor X = $ <br /> 2nd Flool' X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ � �r V�U <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 � Fire <br /> 0 Foundation Survey � Hardcover Removal 0 Septic 0 Water Connection <br /> � Foundation Waterproofing 0 Other(specify) 0 Fireplace � Sewer Connection <br /> �Framing � Masonry � Lawn Irrigation <br /> � Insulation � Mfg. 0 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 /> � 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 /> ��\fnrmc\nlan rcvia�ni rhar41ic4 1f1_7(11F rinrr <br />