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� <br /> .� . '. ` <br /> Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> ' 0 Yes � No Permit Number: 0 Yes ❑ No ❑ N/A � Ye No � <br /> � <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 � 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 � <br /> Investigation Fee c� <br /> SAC— Number of SAC Units � <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 S� Floor X = $ <br /> � 2�d FIOOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �^ (NO �o <br /> r, <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing 0 Site � Plumbing ❑ Grading/ Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control ❑ Mechanical 0 Fire <br /> ❑ Foundation Survey � Hardcover Removal � Septic ❑ Water Connection <br /> 0 Foundation Waterproofing � Other(specify) 0 Fireplace 0 Sewer Connection <br /> �Framing ❑ Masonry � Lawn Irrigation <br /> ❑ Insulation � Mfg. ❑ Landscaping <br /> 0 As-Built Survey � Other(specify) <br /> Final <br /> ❑ Lathe Required State Permits <br /> 0 Other(specify) <br /> � Well Electrical <br /> i <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 /> r\fnrmc\nlan ravic�ni rhorklict 1(1_9f11F rinrv <br />