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. <br /> Shoreland District MCWD Permit j p '(‘ <br /> ��h�.�,k`' Average Lakeshore Setback Bluff /2( <br /> Met? <br /> Yes 0 No Permit Number: /Yes 0 No 0 N/A ❑ Ye 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) /1' <br /> o o <br /> ill 23 4 5 N O cf\a Typs): Type(s):• <br /> f <br /> Fees to be Charged YES NO <br /> Permit V <br /> Plan Review 1,-- <br /> State <br /> /State Surcharge 71/— <br /> Investigation Fee I/`" <br /> SAC—Number of SAC Units V‘ <br /> Other(specify) 1.---- <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1st Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ 670, too <br /> Orono Inspections Required Work Requiring Separate Permits <br /> >\ <br /> XFooting 0 Site lumbing 0 Grading/Filling <br /> ❑ Poured Wall 0 Silt Fence/Erosion Control Mechanical 0 Fire <br /> ❑ Foundation Survey 1 0 Hardcover Removal 0 Septic 0 Water Connection <br /> ❑ 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 2Other(specify) <br /> Final <br /> ❑ Lathe Required State Permits <br /> ❑ Other(specify) <br /> 0 Well lectrical <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 /> Updated: October 2015 <br /> 7.\fnrmc\Nan resuic.nr rharklict I O_9f115 rinry <br />