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L <br /> Shoreland District MCWD Permit Average Lakeshore Setback Bluff � <br /> Met? <br /> Permit Number: 0 Yes 0 No � N/A � Yes 0 <br /> � Yes 0 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 � Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Perm it f,/' <br /> Plan Review <br /> State Surcharge �/' <br /> Investigation Fee f/' <br /> SAC—Number of SAC Units t/ <br /> Other(specify) <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ ��i �m�r <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site � Plumbing � Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control � Mechanical � Fire <br /> 0 Foundation Survey 0 Hardcover Removal � Septic ❑ Water Connection <br /> 0 Foundation Waterproofing 0 Other(specify) ❑ Fireplace ❑ Sewer Connection <br /> �Framing � Masonry 0 Lawn Irrigation <br /> ,[� Insulation � Mfg. 0 Landscaping <br /> � As-Built Survey � Other(specify) <br /> Final <br /> 0 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 /> ❑ 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 rovia�ei rharlrlicf 9(1_9(11�i rinrv <br />