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• <br /> Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: ❑ Yes CINo ElN/A CI Yes ❑ <br /> ❑ Yes ❑ 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) (% 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 /> Permitkr.` <br /> Plan Review 4,/f <br /> State Surcharge v- <br /> Investigation Fee V <br /> SAC Number of SAC Units ' v' <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: $ m <br /> I101 <br /> iI <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing ❑ Site ❑ Plumbing 0 Grading/Filling <br /> El Poured Wall ❑ Silt Fence/Erosion Control ❑ Mechanical ❑ Fire <br /> ❑ Foundation Survey ❑ Hardcover Removal ❑ Septic 0 Water Connection <br /> ❑ Foundation Waterproofing ❑ Other(specify) 0 Fireplace ❑ Sewer Connection <br /> Framing <br /> CI Masonry ❑ Lawn Irrigation <br /> Insulation ❑ Mfg. ❑ Landscaping <br /> ❑ As-Built Survey ❑ Other(specify) <br /> 21Final <br /> 137Lathe Required State Permits <br /> ❑ Other(specify) <br /> 0 Well Electrical <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 /> ,•\fnrmc\nlan raviaui rharklict 1f.9n1 c rinry <br />