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Shoreland District MCWD ermit Average Lakeshpre Setback Bluff <br /> "Met? <br /> O Yes 0 No Permit Number: 0 Y 0 No 0 N/A 0 Ye No 0 <br /> 0 N/A—see attached Setback: <br /> Stormwater Quality Existing 'oposed <br /> Overlay District Tier Hardcover Ha cover Variance Required CUP Required <br /> circle one % and sf % a sf <br /> 0 Yes 0 No 0 Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit <br /> Plan Review <br /> State Surcharge t. <br /> Investigation Fee <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 s' Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ `7 i 0 <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing 0 Site 0 Plumbing 0 Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> 0 Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection <br /> 0 Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> 0 Framing 0 Masonry 0 Lawn Irrigation <br /> 0 Insulation 0 Mfg. 0 Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> Final <br /> 0 athe Required State Permits <br /> 0 Other(specify) <br /> 0 Well 0 Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> 0 See Builder Acknowledgement Form <br /> 0 Prior to release of scrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> An e, 4a `� hmad <br /> G ��� <br /> Updated: October 2015 <br /> 7Afnr c\nInn raviaw rharrlrlict 10-9fNF rinry <br />