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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: � Yes 0 No 0 N/A � Yes 0 <br /> � Yes � 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 s %and sf <br /> 0 Yes � No 0 Yes 0 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 <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 /> Znd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: � /:��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site Plumbing � Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal � Septic 0 Water Connection <br /> � Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> �Framing � Masonry � Lawn Irrigation <br /> �Insulation � Mfg. 0 Landscaping <br /> � As-Built Survey � Other(specify) <br /> Final <br /> � 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 /> � 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 /> �•\fnrme\nlan rAuiaw rhortkliet 1(1_9(11Fi rinrtv . <br />