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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Yes 0 No Permit Number: Yes 0 No 0 N/A 0 YesNo <br /> / <br /> i/E <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 /> i Gt O7O (c{-V770 0 Yes p' No 0 Yes o <br /> LLL/// <br /> ( 1 } 2 3 4 5 �. S� Type(s): / Type(s): <br /> s- 3c02-s- <br /> Fees to be Charged YES NO <br /> Permit <br /> Plan Review �— <br /> State Surcharge (� <br /> Investigation Fee (/' <br /> SAC—Number of SAC Units f <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: $ (e7, mmo <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site 0 Plumbing 0 Grading/Filling <br /> O Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> O Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection <br /> O Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> ACFraming 0 Masonry 0 Lawn Irrigation <br /> - Insulation 0 Mfg. 0 Landscaping <br /> 1s-Built Survey 0 Other(specify) <br /> inal <br /> Lathe Required State Permits <br /> O ether(specify) <br /> 0 Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> m S- - =ui . - owle• • - - -n • • <br /> pS(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 roviwei rhorklict 1fL9M5 rinry <br />