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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> � 0 Yes 0 No Permit Number: 0 Yes 0 No � N/A 0 Yes 0 <br /> No <br /> j 0 N/A—see attached Setback: <br /> d <br /> � Stormwater Quality Existing Proposed <br /> ' Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> circle one %and sf % and sf <br /> j; � Yes � No 0 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 i/' <br />�i <br /> j� Investigation Fee �.,,' <br /> SAC—Number of SAC Units �� r i� <br /> Other(specify) <br /> S uare Foota e $ er S uare Foota e <br /> Basement X = $ <br /> 1s1 Floor �X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �� lYL`�V <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site � lumbing 0 Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control Mechanical 0 Fire <br /> 0 Foundation Survey � Hardcover Removal � Septic 0 Water Connection <br /> � Foundation Waterproofing 0 Other(specify) � Fireplace 0 Sewer Connection <br /> Framing � Masonry 0 Lawn Irrigation <br /> � Insulation � Mfg. 0 Landscaping <br /> � As-Built Survey � Other(specify) <br /> Final <br /> � Lathe Required State Permits <br /> � Other(specify) <br /> 0 Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> � See Builder Acknowledgement Form <br /> O Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �•\fnrme\nlan roviow rhar4licf'I(1_9f11 F rinrv <br />