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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> ¢'Yes 0 No Permit Number: 0 Yes � No N/A � Ye 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 /> Z•'1j$'O70 Z,��'j0 0 Yes � No � Yes � No <br /> 1 2 O3 4 5 ���'� rJ'g� S i �Z.��7 7� TYpe�s�� Type�S�� <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plan Review 1/� <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 St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �� � � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �(Footing 0 Site Plumbing 0 Grading/Filling <br /> � Poured Wall �.Silt Fence/Erosion Control Mechanical 0 Fire <br /> 0 Foundation Survey 0 Hardcover Removal Septic 0 Water Connection <br /> 0 Foundation Waterproofing 0 Other(specify) � Fireplace 0 Sewer Connection <br /> Framing � Masonry 0 Lawn Irrigation <br /> Insulation � Mfg. 0 Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> �Final <br /> � Lathe Required State Permits <br /> � Other(specify) <br /> 0 Well 0 Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> �See Builder Acknowledgement Form <br /> - tions m . <br /> Updated: October 2015 <br /> r\fnrmc\nlan raviaw chor41ic4 1f1_9M.ri rinev <br />