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_.: J �t-I <br /> Shoreland District MCWD Permit '���� '�i� Average Lakeshore Setback Bluff <br /> M et? <br /> '�` � Yes <br /> � Permit Number. 0 Yes � No 0 N/A <br /> Q' Yes � No 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 /> �O•�Z(�� 2+ , Z,QGf p � Yes No 0 Yes No <br /> � 2 3 4 5 --I�aZ � ��D� S� TYPe�S)� TYPe�s)� <br /> �,.J <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plan Review <br /> State Surcharge <br /> Investigation Fee <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> a <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Flool' X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � ❑ Footing ❑ Site ❑ Plumbing ❑ Grading/Filling <br /> � <br /> � Poured Wall � Silt Fence/Erosion Control ❑ Mechanical 0 Fire <br /> � Foundation Survey ❑ Hardcover Removal � Septic 0 Water Connection <br /> ❑ Foundation Waterproofing ❑ 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 /> � Other(specify) <br /> � Well ❑ Electrical <br /> REMARKS (in-house): <br /> a <br /> 1. <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> � See Builder Acknowledgement Form <br /> 0 Prior to releas���escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> r.l�-' <br /> t'�'`� <br /> ��� <br /> ,�� c� 1 <br /> s''�. . ..1` <br /> Updated: October 2015 <br /> �•\fnrmc\nlan ravio�ni nc�rlrlic4 9f1_�(19F rinrv <br />