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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 /> ❑ Yes ❑ No ❑ Yes ❑ No <br /> 1 `2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES_, NO <br /> Permit ✓ / <br /> Plan Review L/ <br /> State Surcharge <br /> Investigation Fee <br /> SAC Number of SAC Units 1� <br /> Other(specify) i_7 <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1st Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X _ $ <br /> VP <br /> Estimated Construction Value: $ 17 ) (p,35 <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 /> ❑ Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection <br /> ❑ Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> ❑ Framing <br /> G KeC-4K t C Od 0 Masonry 0 Lawn Irrigation <br /> ❑ Insulation 6 0 Mfg. 0 Landscaping <br /> ❑ As-Built Survey C as /in <br /> 0 Other(specify) <br /> )1cFinal <br /> ❑ Lathe •n 1 Required State Permits <br /> ❑ Other(specify) ' ' <br /> 0 Well 0 Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> ❑ See Builder Acknowledgement Form <br /> ❑ Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> ,_c e� r 6 ifc larwl, "eelgi- e �? U pit. c./ 47071-- cru <br /> Updated: October 2015 <br /> v.%fnrmc\nlan roviami rhorklict 1 n_9n1 F rinry <br />