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Shoreland District MCWD Permit Average Lakeshore Setback gluff <br /> M et? <br /> 0 Yes 0 No Permit Number: � Yes 0 No � N/A � Ye No � <br /> , <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 /> 0 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 /> SA�— Number of SAC Units <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 /> Estimated Construction Value: $ ��% V[%V <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing � Site lumbing � Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control Mechanical � Fire <br /> 0 Foundation Survey 0 Hardcover Removal 0 Septic � Water Connection <br /> � Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> Framing ❑ Masonry 0 Lawn Irrigation <br /> Insulation 0 Mfg. 0 Landscaping <br /> ❑ As-Built Survey ❑ Other(specify) <br /> Final <br /> � Lathe Required State Permits <br /> � Other(specify) <br /> 0 Well lectrical <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 /> Updated: October 2015 <br /> �•\fnrmc\nlan roviow nc�rklic4 1(1_9M�i rinrr <br />