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• <br /> Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> ❑ Yes ❑ No Permit Number: 0 Yes 0 No 0 N/A <br /> 0 Yes <br /> No 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 /> D Yes D No ❑ Yes D No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit V <br /> Plan Review t ' <br /> State Surcharge t - <br /> Investigation Fee <br /> SAC— Number of SAC Units fr <br /> Other(specify) t` <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1St Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X _ $ <br /> Estimated Construction Value: S .5*--I9 O <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing 0 Site 0 Plumbing 0 Grading/Filling <br /> ❑ Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> D Foundation Survey 0 Hardcover Removal 0 Septic. 0 Water Connection <br /> O Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> raming01 0 Masonry <br /> 0 Lawn Irrigation <br /> Insulation 0 Mfg. ❑ Landscaping <br /> ❑ As-Built Survey 0 Other(specify) <br /> XFinal <br /> D Lathe Required State Permits <br /> O Other(specify) <br /> 0 Well 0 Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> D 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 /> 7•\fnrmc\plan raviaui rharklict in_9n1F rinry <br />