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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: (u —I U� 0 Yes O No 0 N/A 0 Yes <br /> )1__Yes <br /> 0 No 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 % ands % and s <br /> 0 Yes No 0 Yes No <br /> 1 2 4 5 _J 1 .. Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit <br /> Plan Review t� <br /> State Surcharge 1� <br /> Investigation Fee V` <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 n Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ ; V 00 da <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site 0 Plumbing 0 Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> 0 Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection <br /> 0 Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> Framing 0 Masonry 0 Lawn Irrigation <br /> Insulation 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 Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> 0 See Builde . Acknowledgement Form <br /> 0 eleas of esc an as-bui nd har must ed and approved. <br /> Updated: October 2015 <br /> 7•%fnrmc%nla n naviami rrhorklict 1 n_9n 1 F rimy <br />