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�� Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> �� � Permit Number. Yes � No 0 N/A 0 Yes <br /> Yes � No No <br /> N/A-see attached � Setback: <br /> Stormwater Quality Existing Proposed <br /> Overlay District Tier Hardcaver Hardcover Variance Required CUP Required <br /> circle one % and sf % and sf <br /> ���� 0 Yes 'No � Yes o <br /> ( 1' / 2 3 4 5 Type(s): Type(s): <br /> `.� <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plan Review '1'� <br /> State Surcharge <br /> Investigation Fee �•>�� <br /> SAC-Number of SAC Units <br /> Other(specify) <br /> Square Foota e $ per Square Foota e <br /> Basement X - $ <br /> fi 1 St Floor X = $ <br /> 2"d FIOOr X - $ <br /> �: Garage X - $ <br /> Estimated Construction Value: $ �_�, ��� j <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site ❑ Plumbing � Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical ❑ Fire <br /> 0 Foundation Survey 0 Hardcover Removal ❑ Septic 0 Water Connection <br /> ❑ Foundation Waterproofing � Other(specify} ❑ Fireplace 0 Sewer Connection <br /> Framing ❑ Masonry ❑ Lawn Irrigation <br /> � Insulation � Mfg. � Landscaping <br /> s-Built Survey ❑ Other(specify) <br /> Final <br /> ;� <br /> � Lathe Required State Permits <br /> ❑ Other(specify) <br /> 0 Well ❑ Electrical <br /> � <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> ;' �`� See,.B�Crtt�ec Qckn__QwFeti�ement Ft�rm �_�... <br /> �Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> E <br /> Updated: October 2015 <br /> �•\fnrmc\nlan fP\/IPUI nc�rklicf 1f1_9l11F rinrv <br />