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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> Permit Number: ❑ Yes � No � N/A � Yes 0 <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 % 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 t/ <br /> Plan Review V- <br /> State Surcharge ���� �� � ;'� "�`� " <br /> �.��.�� <br /> a��� ��°' ������ <br /> Investigation Fee l/' <br /> �SAC—Number of SAC Unit� �t�s� _: "'����� � �`�,� <br /> Other(specify) �-. <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> � r �^� <br /> Estimated Construction Value: $ !, ��U <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site � Plumbing � Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control 0 Mechanical � Fire <br /> 0 Foundation Survey � Hardcover Removal 0 Septic � Water Connection <br /> � Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> 0 Framing 0 Masonry � Lawn Irrigation <br /> 0 Insulation � Mfg. � Landscaping <br /> 0 As-Built Survey � Other(specify) <br /> Final <br /> � athe 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 to release of escrow money an as-built survey and ardcover c Iculations must be submitted and approved. <br /> l2�'I � � /' � I/'' l�lit, �1.� ' '�/( � <br /> Updated: October 2015 <br /> r\fnrme\nlan rcvic�ei rhar4lief 1(1_9M 5 rinev <br />