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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: ((4 - C'y�" ❑ Yes ❑ No �N/A 0 Yes )1( <br /> 0 Yes XNo n✓ No <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 /> ❑ Yes No ❑ Yes X No <br /> 1 2 3 4 0 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit c./ <br /> Plan Review <br /> State Surcharge 1----- <br /> Investigation <br /> Investigation Fee (/' <br /> SAC—Number of SAC Units <br /> Other(specify) ,t` <br /> Square Footage $ per Square Footage _ <br /> Basement 3.3 z z, X /Uo, 1- Y = $ 353, 03 - 7Z-, <br /> 1s' Floor / O G} X /O , �4 _ $ <br /> 2ndFloor (��J l = , 370 , <br /> 7 5 <br /> � -( -/ X /neo, $ <br /> l0,-L Garage � c� X --6 - = $ q7 5-z,' <br /> . <br /> oa <br /> Estimated Construction Value: $ e 0 // C &�`- <br /> Orono Inspections Required Work Requiring Separate Permits <br /> OFooting 0 Site Plumbing 0 Grading/Filling <br /> Poured Wall Silt Fence/Erosion Control Mechanical 0 Fire <br /> Foundation Survey 0 Hardcover Removal Septic 0 Water Connection <br /> 731 Foundation Waterproofing 0 Other(specify) Fireplace 0 Sewer Connection <br /> Framing 0 Masonry 0 Lawn Irrigation <br /> Insulation -Mfg. 0 Landscaping <br /> As-Built Survey 0 Other(specify) <br /> Final <br /> Lathe Required State Permits <br /> 0 Other(specify) <br /> /Well /Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> ❑ See Builder Acknowledgement Form <br /> ❑ Prior to releas of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br />