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, , <br /> Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> M et? <br /> 0 Yes 0 No Permit Number: � Yes � No 0 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 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 /> Square Footage $ per Square Foota e <br /> Basement X = $ <br /> 15� Floor X = $ <br /> ' 2nd FIOo� X = $ <br /> Garage X = $ <br /> '{ Estimated Construction Value: ����� <br /> � Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing � Site � Plumbing ❑ Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control 0 Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal ❑ Septic � Water Connection <br /> � Foundation Waterproofing �Other(specify) ❑ Fireplace � Sewer Connection <br /> 0 Framing /(�f�C� ,lQ� � Masonry � Lawn Irrigation <br /> � Insulation � � � � � Mfg. ❑ Landscaping <br /> 0 As-Built Survey � �as I«e ,�.,��. � Other(specify) <br /> ' Final <br /> � Lathe ��3� Required State Permits <br /> 0 Other(specify) <br /> � Well 0 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 rovio�ni rharlrlief 1 fl_7h1 F rinrv <br />