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_ �._ _.�r _ <br /> _ . f�.--.-�-�_... ,-.�.�- . .:.,,-_.-�-- ..-�-- �.,��� .<.,,,.. .. _ - . . <br /> Shoreland District MCWD Permit Average Lakeshore Setback gluff <br /> Met? <br /> Permit Number: 0 Yes � No � N/A � Yes 0 <br /> 0 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 /> ❑ Yes 0 No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> ,, <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plars Review � <br /> �, <br /> State Surcharge <br /> Investigation Fee <br /> SAC-Number of SAC Unit� <br /> " Other(specify) <br /> Square Foota e $ per S uare Foota e <br /> Basement X - $ <br /> 1 S� Floor X ' $ <br /> 2"d FIoO� X - $ <br /> Garage X - $ <br /> Estimated Construction Value: $ ! /� � G� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � � Footing 0 Site ❑ Plumbing 0 Grading/Filling <br /> ❑ Poured Wall ❑ Silt Fence/Erosion Control � Mechanical � Fire <br /> 0 Foundation Survey 0 Hardcover Removal 0 Septic ❑ Water Connection <br /> ❑ Foundation Waterproofing � Other(specify) � Fireplace 0 Sewer Connection <br /> Framing 0 Masonry ❑ Lawn Irrigation <br /> � Insulation ❑ Mfg. � Landscaping <br /> � As-Built Survey ❑ Other(specify) <br /> Final <br /> ❑ L the Required State Permits <br /> � Other(specify) <br /> 0 Well 0 Electrical <br /> REMARKS (in-house): <br /> �' -TO BE NOTED ON PERMIT AND INITtALLED: <br /> � OFFICIAL REMARKS <br /> � See Builder Acknowledgement Form <br /> � � Prior to release of escrow money an as�built survey and hardcover calculations must be submitted and approved. <br /> � <br /> f <br /> � <br /> �' <br /> Updated: October 2015 <br /> �•lfnrmc\nlan ravia�ni rharklict 1(1_9(11 F rinrv <br />