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Shoreland District MCWD Permit Average Lakeshore Setback <br /> Met? Bluff <br /> Permit Number: ❑ Yes 0 No 0 N/A 0 Yes 0 <br /> ❑ Yes ❑ NoNo <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 <br /> Type(s): Type(s): <br /> Fees to be Char ed IIIIIVAIIII <br /> a <br /> � r <br /> Plan Review IIIIIIIrAIII <br /> State Surcharge Y ii-. ff:g* ,<„ ',:,`:;-'1,<N'',. <"=c W : ; .t 6ltli, :' <br /> Investigation Fee 111111102111111 <br /> SAC—Ni • - • SACU t <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1st Floor X _ " <br /> $ <br /> 2nd Floor X u. _ <br /> Garage X _ $ <br /> 3 . 0m© <br /> Estimated Construction Value: $ `�. <br /> Orono Inspections Required Wo c Requiring Separate. rmits <br /> ❑ Footing 0 Site Plumbing 13 Grading/Filling <br /> ❑ Poured Wall 0 Silt Fence/Erosion Control Mechanical o 'Fire <br /> ❑ Foundation Survey ❑ Hardcover Removal 0 Septic ❑ Water Connection <br /> ❑ Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> Framing 0 Masonry ❑ Lawn Irrigation <br /> Insulation 0 Mfg. 0 Landscaping <br /> 0 As-Built Survey 0 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 /> ❑ See Builder Acknowledgement Form <br /> O Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br />