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Average Lakeshore Setback Bluff <br /> Shoreland District MCWD Permit Met? <br /> � Yes 0 � <br /> � Yes � No Permit Number: 0 Yes 0 No O N/A 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 /> � Yes 0 No � Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit (� <br /> Plan Review <br /> State Surcharge 1/� <br /> Investigation Fee �� <br /> SAC-Number of SAC Units <br /> Other(specify) <br /> S uare Foota e $ er S uare Foota e <br /> Basement X - $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X - $ <br /> Garage X - $ <br /> � �� <br /> Estimated Construction Value: $ �OD� � � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing 0 Site Plumbing � Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic � Water Connection <br /> � Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> Framing 0 Masonry � Lawn Irrigation <br /> Insulation 0 Mfg. � Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> Final <br /> O 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 /> 0 See Builder Acknowledgement Form <br /> � Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �•\fnrmc\nlan raaviPui nharkliet 1(1_7(11.ri rinrv <br />