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��-��. <br /> Average Lakeshore Setback <br /> Shoreland District MCWD Permit �1,' Met? Bluff <br /> � Yes 0 No Permit Number: � Yes � No � 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 0 Yes � 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 l� <br /> Investigation Fee <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> S uare Foota e $ er Square Foota e <br /> Basement X = $ <br /> 1�Floor X = $ <br /> 2"d FIoOP X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �7�i �00 <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site Plumbing 0 Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control Mechanical �Fire <br /> 0 Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection <br /> 0 Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> raming 0 Masonry 0 Lawn Irrigation <br /> Insulation � Mfg. � Landscaping <br /> � As-Built Survey 0 Other(specify) <br /> inal <br /> 0 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 /> 0 See Builder Acknowledgement Form <br /> ` 0 Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> D� <br /> � � <br /> , `� <br /> J <br /> Updated: October 2015 <br /> r\fnrmclnlan ro�iiow chce4lief 1 fl_9(115 ilnrv <br />