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� Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> Permit Number: � Yes � No 0 N/A � Yes � <br /> � Yes 0 No 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 � 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 <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FIoOP X = $ <br /> Garage X = $ <br /> Q C�7�� <br /> Estimated Construction Value: $ U�, �J / <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site 0 Plumbing 0 Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control � Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic � Water Connection <br /> 0 Foundation Waterproofing � Other(specify) � Fireplace 0 Sewer Connection <br /> � Framing 0 Masonry ❑ Lawn Irrigation <br /> Insulation 0 Mfg. 0 Landscaping <br /> � As-Built Survey � Other(specify) <br /> inal <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 /> 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 ravia��i rhorklict 1f1_7(11F rinrv <br />