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Shorelend District MCWD Permit Av�rage La�s�h?re Se#back B�� <br /> t7 Yes � No P$rmit Number: L7 Yes � No � N!A � YQ No � <br /> ❑ N/A—see attached Setback: <br /> Stormwater t�uality Exist�ng Proposed <br /> Ov�'lay District Tier Hardcover Hardcover Variance Required CUP Required <br /> circie or�e % and s % and s <br /> t7 Yes 0 No C7 Yes 0 No <br /> 1 2 3 4 5 TYi�s)� '�yPs(S�� <br /> r <br /> fees to be Char ed YES NO <br /> �ermit <br /> � <br /> Plan Review <br /> State Surcharge � <br /> lnvestigation Fee . � ., <br /> SAG—t�umber of SAC Units : <br /> Other(specify) <br /> Square Foo#a e $ er S uare Foota e <br /> Basement X = $ � <br /> 1�' Floor x = $ <br /> 2'� F1oor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ <br /> Orono Inspec#ions Required WoNc R�quiring 3eparate Permfits <br /> � Footing ❑ Site O Plumbing 0 Gradir�g/Filling � <br /> � Poured Watl C7 Silt FencelErosion Controt � MEC#18l11C8I ❑ Fire i <br /> � Foundation 3urvey ❑ Hardcover Removai t] Septic C7 Water Connection 't <br /> � Foundation Waterproofing 0 Other(specifyj � Fireplace ❑ Sewer Cannection <br /> D Framing ❑ Masonry 0 Lawn irrigation <br /> ❑ lnsulation � Mfig. ❑ Landscaping <br /> � As-Built Survey [3 Other(specify) <br /> C] Final <br /> ❑ Lathe ,� / f/ Required State Permits <br /> O#her(specifiy) /r�'-�u�fC�!C <br /> ❑ WeA 0 Elec�rical <br /> REMARKS (fn-housej: <br /> OFFICtAt REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> � See Buiider Acknowtedgemen��orm <br /> 0 Prior to�etease of escrow money an as-built survey and hardcover catcuiations m+ast be submitted and approved. <br /> �� Updated; October 2015 <br /> � . . \nlran raviaw charkliat'lf1.9(11.ri(inrv . . . . � . . <br /> rlfnrmc _ <br />