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• <br /> Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: 0 Yes 0 No El N/A 0 Yes 0 <br /> 0 Yes 0 No 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) (% and sf) (%and sf) <br /> D Yes O No D Yes O No <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 _ t1 <br /> Investigation Fee LA <br /> SAC Number of SAC Units _ `- ti� <br /> Other(specify) L---- <br /> Square <br /> /Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1st Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> / � <br /> Estimated Construction Value: $ G/IP 5- <br /> Orono Inspections Required Work Requiring Separate Permits <br /> O Footing 0 Site Plumbing 0 Grading/Filling <br /> O Poured Wall 0 Silt Fence/Erosion Control Mechanical 0 Fire <br /> O Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection <br /> O Foundation Waterproofing 0 Other(specify) tI Fireplace 0 Sewer Connection <br /> 1Araming 0 Masonry 0 Lawn Irrigation <br /> -"FInsulation 0 Mfg. 0 Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> Final <br /> O Lathe Required State Permits <br /> O Other(specify) <br /> 0 Well X.Flectrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> O See Builder Acknowledgement Form <br /> O Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> 7\fnnnc\plan raviow rhorklict 1(1-9(11 c rinry <br />