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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: � Yes � No 0 N/A 0 Yes � <br /> � 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 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 YES NO <br /> Permit <br /> Plan Review <br /> Sta�e Surcharge <br /> Investigation Fee <br /> SAC-Number of SAC Units <br /> Other(specify) <br /> S uare Foota e $ er S uare Foota e <br /> Basement X = $ <br /> 1 St Floor X = � <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> G Footing 0 Site O Plumbing � Grading/Filling <br /> � Poured Wall G Silt Fence/Erosion Control C Mechanical � Fire <br /> � Foundation Survey 0 Hardcover Removal 0 Septic � Water Connection <br /> � Foundation Waterproofing 0 Other(specify) � Fireplace O Sewer Connection <br /> � Framing � Masonry 0 Lawn Irrigation <br /> 0 Insulation 0 Mfg. � Landscaping <br /> � As-Built Survey � Other(specify) <br /> � Final <br /> � Lathe Required State Permits <br /> 0 Other(specify) <br /> � Well � Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> 0 See Builde . Acknowledgement Form <br /> 0 Prior to releas of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �•\fnrmclnlan re�vio�u chocklict 1 fl_9M 5 rinrtv <br />