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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> Permit Number: � Yes � No 0 N/A � Yes ❑ <br /> � Yes 0 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 � No ❑ Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plan Review �J <br /> State Surcharge <br /> Investigation Fee R/` <br /> SAC— Number of SAC Units <br /> Other(specify) (/' <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 S�Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> 1 � <br /> Estimated Construction Value: $ �j(�lP�f <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing ❑ Site ❑ Plumbing 0 Grading/Filling <br /> ❑ Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> ❑ Foundation Survey � Hardcover Removal ❑ Septic ❑ Water Connection <br /> 0 Foundation Waterproofing ❑ Other(specify) 0 Fireplace ❑ Sewer Connection <br /> Framing � Masonry 0 Lawn Irrigation <br /> ❑ Insulation . ❑ Mfg. ❑ Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> Final <br /> ❑ Lathe Required State Permits <br /> 0 Other(specify) <br /> 0 Well Electrical <br /> REMARKS (in-house): <br /> �' <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> � See Builder Acknowledgement Form <br /> 0 Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �•\fnrmc\nlan roviaw rharklic4 9(1_7f115 rinrv <br />