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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> � Permit Number: � Yes � No � N/A � Yes � <br /> � Yes � No 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 °/o and sf (% and sf <br /> � Yes � No 0 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 <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Footage $ er S uare Foota e <br /> Basement X = $ <br /> 1S' Floor X = $ <br /> 2nd FI00� X = $ <br /> � <br /> Garage X = $ <br /> Estimated Construction Value: $ <br /> 1 <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site 0 Plumbing 0 Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic � Water Connection <br /> 0 Foundation Waterproofing 0 Other(specify) � Fireplace � Sewer Connection <br /> � Framing � Masonry 0 Lawn Irrigation <br /> � Insulation � Mfg. � Landscaping <br /> 0 As-Built Survey � Other(specify) <br /> � Final <br /> � Lathe Required State Permits <br /> � Other(specify) <br /> � <br /> � Well 0 Electrical <br /> REMARKS (in-house): � V� / � j �" <br /> C�.hnro�e. <br /> -- T <br /> �ICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> � „ <br /> Contact the City at�52-249-4600 to schedude �r� inspector to visit the s3te an� verify�xist€ng sign size <br /> � prior ta installation of re�r�sign�, A 24-48 ho�€r natic� ss requirPd. proved. <br /> Updated: October 2015 <br /> �•\fnrmc\nlan fP\/IP\�/rhorklict 1(1_�f1'I F rinrv <br />