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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes � No Permit Number: � Yes 0 No 0 N/A � Ye No a <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 /> � Yes � No � 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 <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 Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site 0 Plumbing � Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control � Mechanical 0 Fire <br /> � Foundation Survey � Hardcover Removal � Septic 0 Water Connection <br /> � Foundation Waterproofing � Other(sp,�j ify) / 0 Fireplace � Sewer Connection <br /> � Framing �U�/ �i(���,�/ 0 Masonry 0 Lawn Irrigation <br /> � Insulation t U1 d p Mfg. 0 Landscaping <br /> � As-Built Survey � Other(specify) <br /> Final <br /> � 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 /> 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 rcvia�ni rhorklic4 1f1_9MF rinrv <br />