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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes � No Permit Number: 0 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 /> circie one % and sf %and s <br /> 0 Yes � No � Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit tr <br /> Plan Review �/ <br /> State Surcharge (/ <br /> Investigation Fee t/' <br /> SAC—Number of SAC Units t/' <br /> Other(specify) V <br /> S uare Foota e $ er S uare Foota e <br /> Basement X = $ <br /> 1�Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> / � �Estimated Construction Value: $ G�, �J � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site 0 Plumbing O Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> � Foundation Survey 0 Hardcover Removal � Septic 0 Water Connection <br /> 0 Foundation Waterproofing 0 Other(specify) � Fireplace 0 Sewer Connection <br /> � Framing O Masonry O Lawn Irrigation <br /> 0 Insulation O Mfg. � Landscaping <br /> � As-Built Survey 0 Other(specify) <br /> Final <br /> 0 Lathe Required State Permits <br /> 0 Other(specify) <br /> 0 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 /> Updated: October 2015 <br /> �•\fnrtne\nlan roviPw chortklict 1(1_9M5 rinrtv <br />