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�' <br /> Shoreland District MCWD Permit Average Lakeshore Setback g�uff, <br /> Met? <br /> Permit Number: � Yes 0 No 0 N/A � Yes O <br /> 0 Yes 0 No 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 � Yes � No <br /> 1 2 3 4 "5 Type(s): Type(s): <br /> Fees to be Char ed YES N <br /> Permit � <br /> Plan Review <br /> State Surcharge <br /> Investigation Fee <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 15t Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing 0 Site 0 Plumbing 0 Grading/ Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control � Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal � Septic 0 Water Connection <br /> � Foundation Waterproofing �Other(specify) � Fireplace � Sewer Connection <br /> � Framing A_nC��r.��� � Masonry � Lawn Irrigation <br /> ❑ Insulation ���� � Mfg. � Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> Final <br /> � Lathe Required State Permits <br /> � Other(specify) <br /> � Well ❑ Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> 0 See Builder Acknowledgement Form <br /> ❑ Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> �', <br /> Updated: October 2015 <br /> � r\fnrmc\nlan ravia�ei nc�rklict 1(1_9(11F rinrv <br />