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Average Lakeshore Setback g�uff <br /> Shoreland District MCWD Permit Met? <br /> ; ,� � Yes <br /> � Yes � No Perm't Number: Yes 0 No 0 N/A No <br /> '� 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 /> �.�CO�� C�.�f�� � Yes No � Yes No <br /> � 2 3 4 5 ��0 3(P� S l� .� TYPe�S): TYpe�S�: <br /> Fees to be Char ed YES NO <br /> Perm it <br /> Plan Review <br /> State Surcharge � <br /> Investigation Fee <br /> SAC-Number of SAC Units � <br /> � Other(specify) � �/' <br /> r Square Footage $ per Square Foota e <br /> Basement X - $ <br /> 1 S' Floor X - $ <br /> � 2nd Floor X = $ <br /> Garage X - $ <br /> ' � � <br /> = Estimated Construction Value: � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing ❑ Site lumbing ❑ Grading/Filling <br /> �Poured Wall Silt Fence/Erosion Control echanical � Fire <br /> � Foundation Survey 0 ardcover Removal ❑ Septic ❑ Water Connection <br /> Foundation Waterproofin� � Other(specify) ❑ Fireplace ❑ Sewer Connection <br /> Framing ❑ Masonry ❑ Lawn Irrigation <br /> Insulation � Mfg. � Landscaping <br /> ` � As-Built Survey ❑ Other(specify) <br /> Final <br /> � �Lathe Required State Permits <br /> L <br /> � ❑ Other(specify) <br /> � 0 Well Electrical <br /> �' <br /> � <br /> REirAARKS (in-house): ` <br /> }' <br /> OFF6�fa�t� REMARi(S-TO BE NOTED ON PERMIT AND INITIALLED: <br /> � <br /> �� Builder Acknowledgement Form <br /> Prior to re�ease of escrow m�ney an as-bui t survey and hardcover ca ulations m t be submitted and approved. <br /> ��� �� �-� �'�<� �� `� �� �, �;� �� �; � ��.�,�� . <br /> �'�'� � e ���� <br /> � Updated: October 2015 <br /> . �•\fnrtnc\nlan rcvia�ni rharklict 1(1_9f115 rinrv <br />