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Average Lakeshore Setback g�uff <br /> Shoreland District MCWD Permit Met? <br /> ❑ Yes ❑ No � N/A ❑ Yes ❑ <br /> ❑ Yes ❑ No <br /> Permit Number: 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 Q Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> ; Fees to be Char ed YES NO <br /> Permit <br /> fi Plan Review � <br /> State Surcharge ��' <br /> Investigation Fee <br /> SAC�Number of SAC Units <br /> Other(specify) <br /> Square Foota e $ per Square Foota e <br /> Basement X - $ <br /> 1 St Floor X = $ <br /> a <br /> 2nd Floo� X $ <br /> Garage X - $ <br /> 7 �'�— <br /> Estimated Construction Value: � � � ` � <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 � Septic ❑ Water Connection <br /> ❑ Foundation Waterproofing Q Other(specify) � Fireplace ❑ Sewer Connection <br /> ❑ Framing � Masonry � Lawn Irrigation <br /> ❑ Insulation � Mfg. � Landscaping <br /> ' � As-Built Survey ❑ Other(specify) <br /> '� <br /> '" Final <br /> � Lathe _ Required State Permits <br /> ther(specify)�'Q(rI f �� <br /> � Well ❑ Electrical <br /> r <br /> REMARKS (in-house): <br /> � OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> Q See Builder Acknowledgement Form <br /> � 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 fP\/IPU/rhorklicT 9(1-9f11Fi rinev <br />