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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: D Yes D No D N/A Cl Yes D <br /> D Yes D No No <br /> Cl 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 D No D Yes D No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit <br /> Plan Review L/7 <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 //// 7 X = $ <br /> Estimated Construction Value: $ 4 J ` ZZ • 7 <br /> Orono Inspections Required Work Requiring Separate Permits <br /> D Footing D Site D Plumbing D Grading/Filling <br /> D Poured Wall D Silt Fence/Erosion Control Mechanical D Fire <br /> D Foundation Survey D Hardcover Removal El Septic 0 Water Connection <br /> O Foundation Waterproofing 0 Other(specify) 2EC Fireplace D Sewer Connection <br /> Framing 0 Masonry 0 Lawn Irrigation <br /> Insulation 'Mfg. D Landscaping <br /> D As-Built Survey 0 Other(specify) <br /> Final <br /> O Lathe Required State Permits <br /> O Other(specify) <br /> D Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> D See Builder Acknowledgement Form <br /> D Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> 7.\fnrmc\nlan rnvicui ncarklict 1fl 9ni5 rinry <br />