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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> Permit Number: � Yes 0 No 0 N/A � Yes 0 <br /> 0 Yes � No 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 0 No � 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 Foota e a per S uare Foota e <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ .J, ����� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing 0 Site � Plumbing 0 Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> � Foundation Survey 0 Hardcover Removal � Septic � Water Connection <br /> � Foundation Waterproofing 0 Other(specify) � Fireplace � Sewer Connection <br /> raming 0 Masonry � Lawn Irrigation <br /> �Insulation � Mfg. � Landscaping <br /> 0 As-Built Survey � Other(specify) <br /> Final <br /> O Lathe 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 /> 0 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 /> � �•\fnrmc\nlan rovia�ei rhor4lief 1(1_9MF rin�v <br />