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\ <br /> '\�� /\`P . <br /> �' ' Average Lakeshore Setback <br /> Shoreland District MCWD Permit `` Met? B��ff <br /> 0 Yes �o Permit Number: � GJ._ �?- 0 Yes 0 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 sf %and sf <br /> � /� Yes 0 No � Yes No <br /> 1 2 3 4 ( 5 J 1..�/1� . TYP �S�JL1��, Type(S)� <br /> u <br /> Y� �Jj(` <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 /> S uare Foota e $ er Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ ,���, �(Q (� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site Plumbing 0 Grading/Filling <br /> Poured Wall �Silt Fence/Erosion Control Mechanical 0 Fire <br /> Foundation Survey � Hardcover Removal � Septic � Water Connection <br /> Foundation Waterproofing � Other(specify) �Fireplace � Sewer Connection <br /> Framing 0 Masonry 0 Lawn Irrigation <br /> �,Insulation �Mfg. 0 Landscaping <br /> As-Built Survey Other(specify) <br /> Final <br /> 0 Lathe Required State Permits <br /> � Other(specify) <br /> 0 Well Electrical <br /> REMARKS (in-house):��� J �,�t� • <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> �See Builder Acknowledgement Form <br /> rior to e mone - uilt su r ca cu a ust be s a . <br /> Updated: October 2015 � <br /> �•\fnrmc\nlan raviow rhocklicf 1(1_9f115 rinrtr <br />