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... . . - .,� r <br /> Shoreland District MCWD Permit Average Lakeshore Setback g�uff . <br /> Met? <br /> � Yes � No Permit Number: 0 Yes � No � N/A � Ye 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 /> 0 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 <br /> Plan Review <br /> State Surcharge <br /> Investigation Fee <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Foota e $ per Square Footage <br /> Basement X = $ <br /> 1 S� Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> /� _j <br /> Estimated Construction Value: � (�l% <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing � Site � Plumbing � Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control � Mechanical 0 Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic � Water Connection <br /> 0 Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> Framing � Masonry 0 Lawn Irrigation <br /> Insulation 0 Mfg. O 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 /> 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 rovio�ni rharklie4 1f1_9MF rinrv <br />