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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> � Yes 0 No Permit Number: � Yes � No 0 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 /> 0 Yes 0 No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit <br /> ` Plan Review 1/' <br /> State Surcharge t/� <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 Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ 2 � ��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site � Plumbing 0 Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical ❑ Fire <br /> 0 Foundation Survey � Hardcover Removal ❑ Septic � Water Connection <br /> 0 Foundation Waterproofing � Other(specify) ❑ Fireplace � Sewer Connection <br /> Framing 0 Masonry � Lawn Irrigation <br /> 0 Insulation � Mfg. ❑ Landscaping <br /> � As-Built Survey 0 Other(specify) <br /> " inal <br /> � Lathe Required State Permits <br /> ❑ 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 /> Updated: October 2015 <br /> �•\fnrmc\nlan ravio�ni rhorklicf 1!1_9(115 rinrv <br />