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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes 0 No Permit Number: 0 Yes O No 0 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 s % and sf <br /> � Yes � No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Perm it <br /> Plan Review � <br /> State Surcharge � <br /> Investigation Fee �(/' <br /> SAC—Number of SAC Units � <br /> Other(specify) jj <br /> S uare Footage $ er S uare Foota e <br /> Basement X = $ <br /> 1� Floor X = $ <br /> 2nd FIOo� X = $ <br /> Garage X = $ <br /> �- <br /> Estimated Construction Value: $ �f',"�� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing � Site �Plumbing 0 Grading/Filling <br /> 0 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 � Masonry 0 Lawn Irrigation <br /> 0 Insulation � Mfg. 0 Landscaping <br /> 0 As-Built Survey 0 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 /> � 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 /> �•\fnrmclnlan ravic�iv ehocklic}1(1_9f11F�inev � <br />