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Shoreland Distrjct MCWD Permit Average Lakeshore Setback gluff <br /> Met? <br /> 0 Yes 0 Na Permit Number: � Yes 0 No � 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 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 <br /> State Surcharge <br /> Investigation Fee <br /> SAC—Number of SAC Units �/' <br /> Other(specify) <br /> Square Foota e $ per Square Footage <br /> Basement X = $ <br /> 1 S� Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ / �, (y�� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing 0 Site 0 Plumbing � Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control Mechanical 0 Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic 0 Water Connection <br /> � Foundation Waterproofing � Other(specify) 0 Fireplace 0 Sewer Connection <br /> Framing 0 Masonry � Lawn Irrigation <br /> � Insulation 0 Mfg. 0 Landscaping <br /> � As-Built Survey 0 Other(specify) <br /> Final <br /> � Lathe Required State Permits <br /> � Other(specify) <br /> 0 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 ravia�ni rha�klict 1(1_9(115 rinrv <br />