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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> ❑ Yes 13 No Permit Number: ❑ Yes ❑ No ❑ N/A 13 Yes <br /> 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 ❑ Yes ❑ No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit <br /> Plan Review t/' <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 Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: l GiYV <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing ❑ Site Plumbing [3 Grading/Filling <br /> ❑ Poured Wall 13 Silt Fence/Erosion Control ❑ Mechanical ❑ Fire <br /> ❑ Foundation Survey ❑ Hardcover Removal ❑ Septic ❑ Water Connection <br /> ❑ Fo ndation Waterproofing Other" �� (specify) ❑ Fireplace ❑ Sewer Connection <br /> n <br /> r /�' 44 [3 Masonry 13 Lawn Irrigation <br /> Insulation ❑ Mfg. ❑ 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 /> 7•\fnrmc\n1nn ra\/IPU/rharlrlict 1 n-gn l n,rinry <br />