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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> O Yes 0 No Permit Number: O Yes I] No 0 N/A 0 Ye No 0 <br /> 0 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 Charged YES NO <br /> Permit <br /> Plan Review <br /> State Surcharge C/- <br /> Investigation Fee <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1St Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing 0 Site 0 Plumbing 0 Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> O Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection <br /> 0 Foundation Waterproofing XOther(specify) 0 Fireplace 0 Sewer Connection <br /> 0 Framing // <br /> 0/ Masonry 0 Lawn Irrigation <br /> 0 Insulation 4 <br /> of Cf1Ql� �/a. �S 0 Mfg. 0 Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> Final <br /> 0 Lathe Required State Permits <br /> 0 Other(specify) <br /> 0 Well 0 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 /> 7-\fnrmc\n1nn rauiaui rharlrlicf 1n-,)n1F rinry <br />