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s Average Lakeshore Setback <br /> Shoreland District MCWD Permit Met? Bluff � <br /> � Yes � No Permit Number: � Yes � No � N/A � Ye 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 /> 0 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 V` <br /> State Surcharge V' <br /> Investigation Fee f/' <br /> SAC—Number of SAC Units (� <br /> F Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> 2"d FIo01' X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ /, tI/�� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing ❑ Site Plumbing ❑ Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control � Mechanical 0 Fire <br /> ❑ Foundation Survey 0 Hardcover Removal � Septic ❑ Water Connection <br /> � Foundation Waterproofing � Other(specify) � Fireplace 0 Sewer Connection <br /> Framing � 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 /> � 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 /> ��\fnrmc\nlan rovio�ni nc��41ic4 1 fl_9(19 F rin�r <br />