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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: 0 Yes 0 No � N/A � Yes 0 <br /> � Yes 0 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 /> � Yes � No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit t/� <br /> Plan Review (�'' <br /> State Surcharge v— <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 /> 1s1 Floor -X = $ <br /> 2nd FIOo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �vi vv� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site � Plumbing � Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control �Mechanical 0 Fire <br /> 0 Foundation Survey � Hardcover Removal � Septic � Water Connection <br /> � Foundation Waterproofing 0 Other(specify) � Fireplace 0 Sewer Connection <br /> Framing � Masonry 0 Lawn Irrigation <br /> Insulation � Mfg. � Landscaping <br /> 0 As-Built Survey � Other(specify) <br /> Final <br /> � 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 /> 0 Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �•\fnrtnc\nlan raviow rhor4lict'I(1_9f11ri rinrv <br />