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Shoreland District MCWD Permit Average Lakeshore Setback Beuff <br /> Met? <br /> Permit Number: ❑ Yes ❑ No ❑ N/A ❑ Yes ❑ <br /> 0 Yes � No No <br /> 0 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 /> 0 Yes � No 0 Yes ❑ No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> F'ees to be Char ed YES NO <br /> Perm it <br /> Plan I�eview C/ <br /> State Surcharge 1/ <br /> Investigation Fee l� <br /> SAC- Number of SAC Units �/' <br /> Other(specify) <br /> Square Foota e $ per Square Foota e <br /> Basement X - � <br /> 1 S' Floor X = $ <br /> 2nd Floo� X - $ <br /> ,; <br /> Garage X - $ <br /> 2 � 0 <br /> Estimated Construction Value: $ ✓U1�� <br /> Orono Inspections Required Work IZequiring Separate Permits <br /> ❑ Footing ❑ Site Plumbing ❑ Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control L Mechanical ❑ Fire <br /> � Foundation �urvey Q Hardcover Removal 0 Septic Q Water Connection <br /> ❑ Foundation Waterproofing ❑ Other(specify) � Fireplace ❑ Sewer Connection <br /> �Framing 0 Masonry 0 Lawn Irrigation <br /> �Insulation ❑ Mfg. ❑ Landscaping <br /> ❑ As-Built Survey ❑ Other(specify) <br /> �Final <br /> � Lathe Required State F�ermits <br /> ❑ Other(specify) <br /> � Well �Electrical <br /> REII�AEZKS (in-house): <br /> OFFICIAL REM�►RF(S -TO BE NOTED ON PERMIT A.ND INITIALLED: <br /> ;` . <br /> ❑ See Builcier Acknowledgement Form <br /> � Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �•\fnrmc\nlan ravio�u rhorklict 9(1_9f19F rinev <br />