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1 <br /> I • <br /> Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> � Yes 0 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 /> � Yes � No � 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 fj� <br /> Other(specify) U <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 15t Floor X = $ <br /> 2"d Floo� X = $ <br /> Garage X = $ <br /> ma <br /> Estimated Construction Value: $ � �� � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing 0 Site 0 Plumbing ❑ Grading/ Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control 0 Mechanical ❑ Fire � <br /> 0 Foundation Survey ❑ Hardcover Removal ❑ Septic 0 Water Connection <br /> ❑ Foundation Waterproofing � Other(specify) ❑ Fireplace � Sewer Connection <br /> r�Framing 0 Masonry O Lawn Irrigation <br /> � Insulation 0 Mfg. 0 Landscaping <br /> ❑ As-Built Survey � Other(specify) <br /> Final <br /> 0 Lathe Required State Permits <br /> 0 Other(specify) <br /> 0 Well 0 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 hardcover calculations must be submitted and approved. <br /> } <br /> Updated: October 2015 <br /> ��\fnrmc\nlan ravio�ni rharklicf 1!1_7f11 F rinrv <br />