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�--1 <br /> Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> M et? <br /> � Yes p Na Permit Number: � Yes � No � 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 sf % and sf <br /> 0 Yes � No � Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> � <br /> Permit �/ <br /> � Plan Review (/ <br /> � State Surcharge (� <br /> � <br /> Investigation Fee (/� <br />'� SAC—Number of SAC Units j/' <br /> Other(specify) �' <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> � <br /> Estimated Construction Value: � � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing 0 Site Plumbing � Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control Mechanical � Fire <br /> 0 Foundation Survey 0 Hardcover Removal 0 Septic � Water Connection <br /> 0 Foundation Waterproofing 0 Other(specify) � Fireplace � Sewer Connection <br /> Framing 0 Masonry 0 Lawn Irrigation <br /> Insulation � Mfg. 0 Landscaping <br /> 0 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 Builder Acknowledgement Form <br /> 0 Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> � <br /> � <br /> � <br /> Updated: October 2015 <br /> ��\fnrmc\nlan ravia�u rhorklict 1(1_7(11F rinrv <br />