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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> Permit Number: Yes 0 No � N/A � Yes 0 <br /> �Yes 0 No 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 /> �IO.10�0 �Z.Q¢Qlp Yes � No � Yes No <br /> 1 2 3 4 5 21��T0�0�� c3�� �� ST� Y e(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plan Review (/� <br /> State Surcharge V <br /> Investigation Fee ✓� <br /> SAC—Number of SAC Units 4l <br /> Other(specify) <br /> S uare Foota e $ per S uare Foota e <br /> Basement X = $ <br /> 1� Floor X = $ <br /> 2"d Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �'��T,d�� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site Plumbing 0 Grading/Filling <br /> Poured Wall Silt Fence/Erosion Control Mechanical � Fire <br /> Foundation Survey � Hardcover Removal 0 Septic � Water Connection <br /> Foundation Waterproofing � Other(specify) ireplace 0 Sewer Connection <br /> Framing � Masonry � Lawn Irrigation <br /> Insulation Mfg. 0 Landscaping <br /> As-Built Survey Other(specify) <br /> Final ���L <br /> Lathe Required State Permits <br /> � Other(specify) <br /> 0 Well Electrical <br /> REMARKS (in-house): <br /> OF ICIAL 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 /> �, �tit•.c�`S G6Y►��'►��,fiS t.� i ?-�I � IS �-1 p�l ( t�'� a c-��n01 Y�o�o���'J-P,vYbwl�--: <br /> Updated: October 2015 <br /> �•\fnrmc\nlan rp�iiAw rhorklicf 1�1_9M.ri rinev <br />