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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> M et? <br /> 0 Yes p No Permit Number: 0 Yes 0 No � 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 sf % and sf <br /> 0 Yes 0 No 0 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 f�' <br /> Other(specify) <br /> Square Foota e $ per Square Footage <br /> Basement X = $ <br /> 1St Floor � X ��•5'p = $ --� <br /> 2nd FIoO� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ Cp; �� `� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site � Plumbing � Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control 0 Mechanical � Fire <br /> ❑ Foundation Survey 0 Hardcover Removal � Septic 0 Water Connection <br /> 0 Foundation Waterproofing 0 Other(specify) � Fireplace 0 Sewer Connection <br /> Framing � Masonry 0 Lawn Irrigation <br /> � Insulation � Mfg. ❑ Landscaping <br /> � s-Built Survey � Other(specify) <br /> Final <br /> � Lathe Required State Permits <br /> � 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 /> ❑ 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 ravia�u rhar4liet 1(1_7(11F rinrv <br />