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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> � Yes 0 No Permit Number: 0 Yes 0 No � 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 � No � Yes 0 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 FIOOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ T��„� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site � Plumbing ❑ Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control ❑ Mechanical � Fire <br /> 0 Foundation Survey � Hardcover Removal � Septic � Water Connection <br /> 0 Foundation Waterproofing 0 Other(specify) � Fireplace ❑ Sewer Connection <br /> �' Framing 0 Masonry ❑ Lawn Irrigation <br /> 0 Insulation � Mfg. 0 Landscaping <br /> 0 As-Built Survey ❑ Other(specify) <br /> Final <br /> Lathe Required State Permits <br /> 0 Other(specify) <br /> 0 Well � 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 ra�iio�ni rhorklie4 1f1_9(19F rinrv <br />