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' ' ! <br /> Average Lakeshore Setback <br /> Shoreland District MCWD Permit Met? Bluff <br /> � Yes � No Permit Number: � Yes 0 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 0 No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit <br /> Plan Review <br /> State Surcharge <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 FIOOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ ��( �ly D �— <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site ❑ Plumbing � Grading/ Filling <br /> � Poured Wall � Silt Fence/Erosion Control Mechanical 0 Fire <br /> 0 Foundation Survey 0 Hardcover Removal � Septic � Water Connection <br /> ❑ Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> �'Framing � Masonry � Lawn Irrigation <br /> � Insulation � Mfg. � Landscaping <br /> � As-Built Survey ❑ 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 /> 0 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 ravio�ni nc�rklicf 1f1_9l11F rinrv <br />