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�, <br /> Average Lakeshore Setback <br /> Shoreland District MCWD Permit Met? B�u� <br /> � Yes � No Permit Number: 0 Yes � No 0 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 /> � Yes � No � Yes 0 No <br /> 1 2 3 4 5 Type(s): � Type(s): <br /> Fees to be Char ed YES NO <br /> Permit l./' <br /> Plan Review (/' <br /> State Surcharge (/� <br /> Investigation Fee 1/' <br /> SAC— Number of SAC Units � <br /> Other(specify) <br /> Square Foota e $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FIOOr X = $ <br /> Garage X = $ <br /> ✓�,/y� ,�yr� � <br /> Estimated Construction Value: $ JW, �W <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site Plumbing � Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control Mechanical 0 Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic 0 Water Connection <br /> 0 Foundation Waterproofing ❑ Other(specify) � Fireplace 0 Sewer Connection <br /> Framing � Masonry 0 Lawn Irrigation <br /> Insulation 0 Mfg. 0 Landscaping <br /> 0 As-Built Survey � Other(specify) <br /> inal <br /> ❑ 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 /> ; <br /> � Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> � <br /> :; <br /> k <br /> Updated: October 2015 <br /> �•\fnrmc\nlan rc�iio�ni rhar4lict 1(1_9h1F rinrv <br />