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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: O Yes � No � N/A � Yes � <br /> � Yes 0 No 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 0 No � 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 l/ <br /> State Surcharge �/ <br /> Investigation Fee <br /> SAC—Number of SAC Units 1� <br /> Other(s�ecify) 1/' <br /> S uare Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ ��.!/, ��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing � Site Plumbing � Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control Mechanical � Fire <br /> O Foundation Survey 0 Hardcover Removal 0 Septic � Water Connection <br /> 0 Foundation Waterproofing � Other(specify) � Fireplace � 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 /> 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 /> 0 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�iiaw chPeklict 1(1_9f11Fi rinrv <br />