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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes 0 No Permit Number: 0 Yes 0 No 0 N/A ❑ YesNo 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 /> ❑ Yes ❑ No ❑ Yes ❑ No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit l/ <br /> Plan Review r <br /> State Surcharge <br /> Investigation Fee (/- <br /> SAC— Number of SAC Units <br /> Other(specify) 1,- <br /> Square Footage $ per Square Footage <br /> Basement 50 71t-. X ` 6.5-o = $ s4 6 IQ <br /> 1St Floor -2m 6 X j a) , CO _ $ .// �lJ V C' �J <br /> 2nd Floor / 5- X 74. Co = $ z 5 74-- <br /> Garage X = $ <br /> Estimated Construction Value: $ r `� , L.,,`, <br /> Orono Inspections Required J Work Requiring Separate Permits <br /> yFooting 0 Site ,.Plumbing 0 Grading/Filling <br /> ❑ Poured Wall 0 Silt Fence/Erosion Control )1 Mechanical 0 Fire <br /> ❑ Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection <br /> ❑ Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> Framing <br /> 0 Masonry 0 Lawn Irrigation <br /> Insulation ❑ Mfg. ❑ Landscaping <br /> ❑ As-Built Survey 0 Other(specify) <br /> inal <br /> ❑ Lathe Required State Permits <br /> ❑ Other(specify) <br /> ❑ Well XElectrical <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 /> v•\fnrmc\nlan ravialni ncarklicf 1nAf11 c rinry <br />