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, , . <br /> Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> 0 Yes 0 No Permit Number: � 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 /> � 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 /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �-� ��� � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing 0 Site Plumbing � Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal � Septic 0 Water Connection <br /> � Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> raming ❑ Masonry 0 Lawn Irrigation <br /> Insulation 0 Mfg. 0 Landscaping <br /> � As-Built Survey ❑ Other(specify) <br /> Final <br /> 0 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 /> 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 /> �•\fnrmc\nlan rcvia�ei rhorklict 1f1_7h1F rinrv <br />