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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: (n _ 0 Yes 0 No N/A 0 Yes <br /> 0 Yes �No v`Y No <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 % ands % and s <br /> 0 Yes No 0 Yes VKNo <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 /> 1st Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ -7 200 <br /> Orono Inspections Required Work Requiring Separate Permits <br /> X-Footing 0 Site Plumbing 0 Grading/Filling <br /> oured WallSilt Fence/Erosion Control Mechanical 0 Fire <br /> oundation Survey 0 ardcover Removal Septic 0 Water Connection <br /> Foundation Waterproofing 0 Other(specify) Fireplace 0 Sewer Connection <br /> Framing 0 Masonry 0 Lawn Irrigation <br /> 1�t_ <br /> nsulationMfg. 0 Landscaping <br /> As-Built Survey Other(specify) <br /> Final <br /> Lathe Required State Permits <br /> 0 Other(specify) <br /> Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> �eBde . Acknowledgement Formeleas money an as- ey and har and a <br /> Updated: October 2015 <br /> 7•1fnrmc\n1an raviow rharie ict 1fL9Mq rinry <br />