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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: O Yes 0 No � N/A � Yes � <br /> � Yes � No 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 /> S uare Foota e $ er S uare Foota e <br /> Basement X = $ <br /> 1�Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> ; � � _ <br /> Estimated Construction Value: - <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing 0 Site � Plumbing 0 Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control 0 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 /> Framing 0 Masonry � Lawn Irrigation <br /> 0 Insulation 0 Mfg. � Landscaping <br /> 0 As-Built Survey � Other(specify) <br /> " Final <br /> 0 Lathe Required State Permits <br /> 0 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 /> � 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 ro�iicui chcc4lict 1(1_9f115 rinnv <br />