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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Yes O No Permit Number: � Yes � No 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 s %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 � <br /> State Surcharge <br /> Investigation Fee �,/' <br /> SAC—Number of SAC Units 'l/' <br /> Other(specify) <br /> Square Foota e $ er Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2"d FIoOI' X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ ��. �� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site � Plumbing 0 Grading/Filling <br /> 0 oured Wall O Silt Fence/Erosion Control � Mechanical � Fire <br /> 0 Foundation Survey � Hardcover Removal 0 Septic � Water Connection <br /> 0 Foundation Waterproofing O Other(specify) 0 Fireplace � Sewer Connection <br /> � Framing � Masonry � Lawn Irrigation <br /> 0 Insulation � Mfg. � Landscaping <br /> �As-Built Survey � Other(specify) <br /> Final <br /> 0 Lathe Required State Permits <br /> � Other(specify) <br /> � Well � Electrical <br /> �� j� � <br /> REMARKS (in-house): G L �r�- 2 ' � � �` , �r % � `�j � 1�L-�S <br /> C,P=� _ <br /> �-�� � �, c�� _ '` Z s , �3 r C�1= Sr e��� <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: � 'Z�,� f� _ �Z � <br /> S ui w e or <br /> � �� <br /> 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 rnviaw ch�+r4lict 1(1_9(11ri rinrtv <br />