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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> � Yes � No Permit Number: � Yes � No 0 N/A � Ye No � <br /> O 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 s <br /> � Yes 0 No � Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed ,:Y,�S_�.,���:: ,,:,:�V�{..;� <br /> _ ,�� �����,�.p,_�.,rh„�a�s�'L�: '-'14',�p a,�e,�k;- �-c',5."i�t`-_- xr -'",.,�.:z� _ �. <br /> M . .. _�� e: - -, <br /> :i t��4t�bs�+��t'��,.L`"'� � <br /> . ... . _ <br /> Plan Review � <br /> -x ..� . _ . .�x � <br /> -;s tt x e 'd.z' ¢":. rfi�. 3,..:�it"`" �`��s` <br /> s�.�i^�"���a�- 1°� �s'3���`*�.-�' <br /> Investigation Fee ✓ <br /> a � -���; ,, r � :.,.. <br /> - --r. ���...t n:* _ :,''d,��:i�' _ ._��*°� ��.x� -��;,�a "` .�i,�.�,', <br /> . . .. .. ., a.. ,. _� �:z <br /> Other(specify) � <br /> S uare Foota e a er S uare Foota e <br /> Basement X = $ <br /> 1 S�Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ � � �O <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site Plumbing � Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control echanical 0 Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic 0 Water Connection <br /> � Foundation Waterproofing O Other(specify) � Fireplace � Sewer Connection <br /> Framing O Masonry 0 Lawn Irrigation <br /> � Insulation � Mfg. 0 Landscaping <br /> 0 As-Built Survey O Other(specify) <br /> Final <br /> � Lathe Required State Permits <br /> � Other(specify) <br /> 0 Well 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 rr��riow rthpr4licf 1 fl_9f11.ri rinrv <br />