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".; + <br /> � <br /> Shoreland District MCWD Permit �!� �,t Average Lakeshore Setback ��uff <br /> Met? <br /> � Yes No Permit Number: � Yes � No N/A � Ye No <br /> � Setback: <br /> 0 N/A—see attached <br /> > Stormwater Quality Existing Proposed <br /> Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> circle one % and sf % and sf <br /> Yes 0 No 0 Yes No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> �` Permit V' <br /> Plan Review � <br /> State Surcharge <br /> Investigation Fee �/' <br /> SAC—Number of SAC Units ' <br /> Other(specify) �,,..-- <br /> S uare Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> Estimated Construction value: $���� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing � Site ❑ Plumbing 0 Grading/Filling <br /> � Poured Wall ❑ Silt Fence/Erosion Control 0 Mechanical ❑ Fire <br /> ❑ Foundation Survey 0 Hardcover Removal ❑ Septic ❑ Water Connection <br /> O Foundation Waterproofing � Other(specify) ❑ Fireplace 0 Sewer Connection <br /> Framing ❑ Masonry 0 Lawn Irrigation <br /> �' ❑ Insulation ❑ Mfg. rJ Landscaping <br /> 0 As-Built Survey ❑ Other(specify) <br /> Final <br /> ❑ Lathe Required State Permits <br /> ❑ Other(specify) <br /> 0 Well Electrical <br /> � REMARKS (in-house): � �� ' v � <br /> i�,�$ �� ✓ � ' d <br /> � OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> � S uilder gemen Q��,/Ilaf�' <br /> .� Prior to release of escrow money an a -built survey I � must be sub 'ted and approved. <br /> � � S� �. � <br /> � • ,� 6 A.CCP.�u r '� mC�. <br /> , � �A'Y1 M�.W� �Si C�1'�0 Ih i�' <br /> � Updated: October 2015 � <br /> ��\fnrmc\nlan rcvio�u rharklict 1(1_9(115 rinrv <br /> i,. <br />