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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> Yes 0 No Permit Number: � Yes � No N/A � Ye No �' <br /> G 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 /> {� (5,Z�f�j 'JC.c�U�-j Yes O No � Yes � No <br /> 1 U 3 4 5 G c p s):' , t Type(s): <br /> �t0�...)�� ��JzGP LS� �L <br /> Fees to be Char ed YES NO <br /> Pernr�t <br /> Plan Review <br /> Sta#e Su�charge <br /> Investigation Fee <br /> SAC-f�umber of SAC Units <br /> Other(specify) <br /> S uare Foota e $ er S uare Foota e <br /> Basement X = $ <br /> 1� Floor X = $ <br /> 2nd FIoOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site � Plumbing 0 Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion�Control � Mechanical 0 Fire <br /> 0 Foundation Survey 0 Hardcover Removal 0 Septic � Water Connection <br /> G Foundation Waterproofing 0 Other(specify) � Fireplace 0 Sewer Connection <br /> Framing 0 Masonry � Lawn Irrigation <br /> � Insulation G Mfg. 0 Landscaping <br /> As-Built Survey � Other(specify) <br /> G inal <br /> G 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 /> ,�1 See Builde Acknowledgement Form <br /> V � <br /> . :;�;t ea ney an as-bui survey and hardcover ations mus o ed. <br /> � <br /> 1 — <br /> Updated: October 2015 <br /> �•\fnrm¢\nlan rcaviaiu rhorklic4 1f1_7(115 rinrv <br />