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; <br /> Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> � Yes 0 No Permit Number: � Yes ❑ No 0 N/A � Ye 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 s <br /> 0 Yes � No � Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit t <br /> Plan Review <br /> State Surcharge �/' <br /> 's <br /> Investigation Fee <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> S uare Foota e $ er S uare Foota e <br /> ; Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FIoOr X = $ <br /> Garage X = $ <br /> �. <br /> Estimated Construction Value: $ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing � Site � Plumbing � Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical � Fire <br /> � Foundation Survey 0 Hardcover Removal � Septic � Water Connection <br /> � Foundation Waterproofing 0 Other(specify) � Fireplace � Sewer Connection <br /> 0 Framing 0 Masonry 0 Lawn Irrigation <br /> ❑ Insulation � Mfg. � Landscaping <br /> £ � As-Built Survey 0 Other(specify) <br /> Final <br /> 0 athe Required State Permits <br /> � Other(specify) <br /> � Well 0 Electrical <br /> V <br /> REMARKS (in-house): <br /> � <br /> OFFICIAL REMARKS -TO BE NOTED ON RERMIT AND INITIALLED: <br /> � See Builder Acknowledgement Form <br /> � Prior to release of escrow money an as-built survey and hardcover calculations must be sy�bmitted and appr ved. <br /> ,^o r d i� i� � {' � ,�m � � t� lle � <br /> ��c� i,� s � ��� <br /> Updated: October 2015 <br /> �•Ifnrmclnlan roviaw chcc41ic4 9(1_9(11.ri rinnv <br />