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��„ <br /> °�,u�� <br /> �:° Average Lakeshore 8etback <br /> Shoreland District MCWD Permit �,:✓ Met? B�u� <br /> � <br /> Yes 0 No Permit Number: � 0 Yes No � N/A � Yes <br /> � 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 /> Yes � No 0 Yes o <br /> 1� 2 3 4 5 � T pe(s): Type(s): <br /> l/ <br /> Fees to be Char ed YES NO <br /> Permit d/ <br /> Plan Review �/ <br /> a State Surcharge <br /> c; Investigation Fee ✓ <br /> ; SAC—Number of SAC Units !/ ������� ��J�°�° <br /> Other(specify) �/' <br /> S uare Foota e $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2"d Floo� X = $ <br /> ; Garage X = $ <br /> Estimated Construction Value: $ �`� i��� <br /> �� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �' ❑ Footing 0 Site Plumbing � Grading/Filling <br /> � Poured Wall � Silt FencelErosion Control Mechanical ❑ Fire <br /> 0 Foundation Survey � Hardcover Removal � Septic � Water Connection <br /> � Foundation Waterproofing ❑ Other(specify) Fireplace ❑ Sewer Connection <br /> Framing � Masonry ❑ Lawn Irrigation <br /> ; �Insulation �Mfg. 0 Landscaping <br /> ° ❑ As-Built Survey 0 Other(specify) <br /> Final <br /> "�Lathe Required State Permits <br /> 0 Other(specify) <br /> 0 Well Electrical <br /> 3 <br /> REMARKS (in-house): <br /> �: <br /> OFFICIAL REMARKS-TO BE NOTED OIV PERMIT AND INITIALLED: <br /> ' �See Builder Acknowledgement Forrr� <br /> � Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> ? �•\fnrmclnlan ravio�ni rhorlrlict 9 fl_9(11 F rinrv <br />