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� <br /> ' �. <br /> Shoreland District MCWD Permit Average Lakesh�ore Setback g�uff <br /> �� Met. <br /> � Yes � No Permit Number. I� _ Z�? � Yes � No �N/A � Y� 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 /> �g,� �Jp ��,q � Qj0 Yes � No � Yes o ' <br /> 1� 2 3 4 5 (� <br /> 2Z�ST� J�4� �� ype 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) L� <br /> Square Foota e $ er Square Foota e <br /> Basement X = $ <br /> 1St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: l ��`�V <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site � Plumbing � Grading/Filling <br /> 0 Poured Wall Silt Fence/Erosion Control echanical � Fire <br /> � Foundation Survey 0 Hardcover Removal 0 Septic � Water Connection <br /> 0 Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> Framing � Masonry � Lawn Irrigation <br /> Insulation � Mfg. � Landscaping <br /> As-Built Survey 0 Other(specify) <br /> Final <br /> ; Lathe Required State Permits <br /> 0 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 /> Prior as o e ne ilt survey be submitted ved. <br /> � <br /> Updated: October 2015 <br /> �•\fnrmc\nlan rovia�ni nc�rklict 1!1_9f11 F rinrv <br />