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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> �Yes 0 No Permit Number: � Yes �No 0 N/A � Ye No <br /> N/A—see attached a�; L 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 � Yes No <br /> ( 1 ) 2 3 4 5 v . ._ , pe(S):t..� It�ib►'1 Type(s): <br /> LJ � _ <br /> i <br /> �1 i rC� I lY�I� �1 S bd�4lUC'I QV pXO��• <br /> Fees to be Char ed YES NO luK�31�►� <br /> Permit t." �{�C.� <br /> Plan Review <br /> State Surcharge <br /> Investigation Fee � <br /> ` SAC— Number of SAC Units <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 S� Floor X = $ <br /> 2nd FIOOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ , <br /> � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ooting ❑ Site Plumbing � Grading/Filling <br /> 0 Poured Wall ❑ Silt Fence/Erosion Control Mechanical 0 Fire <br /> ❑ Foundation Survey ❑ Hardcover Removal 0 Septic 0 Water Connection <br /> 0 Foundation Waterproofing ❑ Other(specify) 0 Fireplace 0 Sewer Connection <br /> Framing ❑ Masonry � Lawn Irrigation <br /> �Insulation ❑ Mfg. 0 Landscaping <br /> � As-Built Survey 0 Other(specify) <br /> Final <br /> 0 Lathe Required State Permits <br /> 0 Other(specify) <br /> � Well Electrical <br /> REMARKS (in-house): <br /> � OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: ���� <br /> Se ' er A <br /> � n r to rel�ase of esefow mon�y'an as-built sutv�y�nd hardcover calculations must-be submit#ed and approv�d. <br /> , ,� � � <br /> ��'�'�'. ���L�I����lf;; �I����� <br /> . <br /> Updated: October 2015 <br /> �•\fnrmc\nlan ravic�u rharlrlict 1(1_9(19F flnrv <br />