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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> � Yes 0 No Permit Number: 0 Yes � No � N/A � Ye 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 /> 0 Yes 0 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 1/ <br /> Other(specify) <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FIOOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ ����,�(���� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site Plumbing 0 Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control Mechanical � Fire <br /> � Foundation Survey 0 Hardcover Removal � Septic � Water Connection <br /> � Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> Framing � Masonry � Lawn Irrigation <br /> Insulation 0 Mfg. � Landscaping <br /> � As-Built Survey 0 Other(specify) <br /> Final <br /> � Lathe Required State Permits <br /> � Other(specify) <br /> 0 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 ravic�ni�horklic4 1f1_9M�i rinrv <br />