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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> Permit Number: �� -� � 0 Yes 0 No N/A 0 Yes <br /> �es � 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 /> ` �C,00Ut� � Yes No � Yes No <br /> 1 � 3 4 5 � 3ffi� �� Type(s): Type(s): <br /> Y <br /> Ci C�GtA— �C,�tc� �`�-]L <br /> Fees to be Char ed YES NO <br /> Permit l/� <br /> Plan Review l/ <br /> State Surcharge (/- <br /> Investigation Fee �/' <br /> SAC—Number of SAC Units <br /> Other(specify) �/ <br /> Square Foota e $ per Square Footage : <br /> Basement X = $ <br /> 1 S� Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> ,� � <br /> Estimated Construction Value: $ �,��,��l l <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site Plumbing ❑ Grading/Filling <br /> Poured Wall Silt Fence/Erosion Control �Mechanical 0 Fire <br /> Foundation Survey ❑ Hardcover Removal 0 Septic �Water Connection <br /> Foundation Waterproofing ❑ Other(specify) �Fireplace Sewer Connection <br /> Framing � Masonry 0 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): � /�VQ � ��� <br /> 2 J lu.. � 'l 40 <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> � �See Builder Acknowledgement Form <br /> rior to o escr an as- ' ver calculations m <br /> Updated: October 2015 <br /> ��\fnrmc\nlan ravio�u rharklict 9 fl_9l11 F rinrv <br />