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Shoreland District MCWD Permit Average La'kNes�re Setback g�uff <br /> Permit Number: es No � N/A 0 Yes <br /> �Yes G No No <br /> � N/A-see attached Setback: <br /> Stormwater Quality Existing Proposed <br /> Overlay District Tier Hardcover Hardcover V ian e R quir d CUP Required <br /> circle one ' ` %and s %and s <br /> Z�70�/ Z�s?� Yes O No 0 Yes No <br /> � 2 3 4 5 �b`�� t����/p y e(s : Type(s): <br /> r � <br /> , !f�� ��3 <br /> Fees to be Char ed YES NO <br /> Permit <br /> . Plan Review <br /> S�te Surct�rge . <br /> . � . , Investigation Fee <br /> SAC-Mumber of SAC Unit� <br /> Other(specify) <br /> S uare Foota e $ er S uare Foota e <br /> Basement / z z X 3 5..� _ $ <br /> 1�Floor X = $ <br /> 2nd Floo� X - $ <br /> Garage X = <br /> Estimated Construction Value: $ � � (j ��� �t �• �� <br /> Orono Inspections Required Work Ri <br /> � ��. g9 <br /> .3 (o,� <br /> � Footing � Site � Plumbing �•Q�� � <br /> G Poured Wall �Silt Fence/Erosion Control O Mechanical �'� ylAl/��l�Gu� <br /> O Foundation Survey 0 Hardcover Removal G Septic .r ..,,,,,. .,,,....___._.. <br /> � Foundation Waterproofing O Other(specify) 0 Fireplace � Sewer Connection <br /> 0 Framing � Masonry � Lawn Irrigation <br /> 0 I sulation 0 Mfg. 0 Landscaping <br /> As-Built Survey � ��� � Other(specify) <br /> Final <br /> 0 Lathe Required State Permits <br /> � Other(specify) <br /> G Well G Electrical <br /> REMARKS (in-house): f�l. � Y vv 1��j (� �� � �' (j{��� �(j <br /> V �' y <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AN T LE : M (�{' I�VI�f"�e�►�s'C� <br /> See B ' e . Ac ent Form � ���� � � <br /> ���p�%(�Gt� �10V��VII�JI"' <br /> �Prior to releas of escrow money an as-built survey an hardcover calculations must be submitted and ap roved. <br /> _ � �z d <br /> s � � t!� �ec f t�w <br /> ��'�°ih���fid �c�v�V l!�d�( �� <br /> Updated: October 2015 V'1 �v� 1 <br /> �•\fnrmc\nlan rovipw�hoc�lict 1(1_9M F rinrtv � <br />