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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Yes O No Permit Number: ` _ 0 Yes No O N/A 0 Ye QA No <br /> 0 N/A—see attached Va►i g1' ( Setback: <br /> Stormwater Quality Existing Proposed <br /> Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> circle one % and sf %and sf <br /> 23 -59 10 Yes 0 No 0 Yes XNo <br /> O1 2 3 4 5 Tpe(s): Type(s): <br /> 9, 051 5 <br /> W 4f�% <br /> Fees to be Charged 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 $ er Square Foota e <br /> Basement X = $ <br /> 1 st Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site Plumbing 0 Grading/Filling <br /> Poured Wall Silt Fence/Erosion Control [ Mechanical 0 Fire <br /> Foundation Survey 0 Hardcover Removal 0 Septic Water Connection <br /> Foundation Waterproofing 0 Other(specify) Fireplace Sewer Connection <br /> Framing 0 Masonry 0 Lawn Irrigation <br /> Insulation 0 Mfg. 0 Landscaping <br /> As-Built Survey 0 Other(specify) <br /> Final <br /> Lathe Required State Permits <br /> 0 Other(specify) <br /> F13 Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> -,(See Builder Acknowledgement Form <br /> Prior as-built surve lations must be submitted and approved. <br /> Updated: October 2015 <br /> 7•1fnrmcWmn roviout nhonklicf 1(_,)ovx;rinnv <br />