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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> � Yes 0 No Permit Number: � Yes � No 0 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 s %and sf <br /> 0 Yes 0 No CI 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 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 /> 15t Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ /��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing � Site � Plumbing � Grading/Filling <br /> �a'Poured Wall � Silt Fence/Erosion Control � Mechanical � Fire <br /> 0 Foundation Survey � Hardcover Removal 0 Septic 0 Water Connection <br /> 0 Foundation Waterproofing � Other(specify) 0 Fireplace 0 Sewer Connection <br /> Framing � Masonry � Lawn Irrigation <br /> � Insulation 0 Mfg. � Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> Final <br /> 0 Lathe Required State Permits <br /> O Other(specify) <br /> 0 Well 0 Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> 0 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 /> v\fnrmc\nlan raviow rhor4licf 1(1_9MF rinrv <br />