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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes No Permit Number: 0 Yes 0 No /A 0 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) <br /> ❑ Yes DYes No <br /> 1 2 3 4 0 __—, ...------ Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit I/ <br /> Plan Review i.----- <br /> State Surcharge Imo- <br /> Investigation Fee l/' <br /> SAC—Number of SAC Units l./' <br /> Other(specify) l/. <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1St Floor X = $ <br /> • <br /> 2"d Floor X = $ <br /> Garage X = $ <br /> 00 <br /> Estimated Construction Value: $ g zi,,coo <br /> Orono Inspections Required Work Requiring Separate Permits <br /> /)( <br /> Footing 0 Site Plumbing 0 Grading/Filling <br /> ❑ Poured Wall 0 Silt Fence/Erosion Control Mechanical 0 Fire <br /> O Foundation Survey 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 <br /> /5(Mfg. ❑ Landscaping <br /> As-Built Survey Other(specify) <br /> Final <br /> ❑ Lathe Required State Permits <br /> ❑ Other(specify) <br /> 0 Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: (' <br /> • - • B • - ' now - . _ - - or Mesh^9 l of kt4 C l(s 1�Ut r 4iu,�1L� <br /> • Prior to release of escrow money an as-built survey ust be submitted and approved. <br /> X1 /1 - Si Nk— coln ITO I un h ! klk01 ' tan .f2_,L- <br /> nt- 1 liS . d• <br /> Updated: October 2015 <br /> ,•\fnrmc\nlan ravine,rharlrlict 1f_9n1F rinry <br />