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1`���°' ,,�c�' <br /> Shoreland District MCWD Permit � f � „ r�E* v Average Lakeshore Setback Bluff <br /> ,� Met? <br /> � / Permit Number: � Yes ❑ No N/A Q Yes <br /> 0 Yes jd No No <br /> / ❑ N/A- see attached Setback: <br /> `' Stormwater Quality Existing Preposed <br /> �' Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> f circle one % and sf % and sf <br /> � Yes No 0 Yes No <br /> 1 2 3 4 5 .�.-�------��-- -� Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Perm it 1/ <br /> Plan RevieHr <br /> State S�rcharge ' <br /> Investigation Fe� <br /> SAC-Nurrtber of SAG lJn6ts � <br /> Other(specify) ��` <br /> Square Foota e $ per Square Foota e <br /> Basement X - $ <br /> 1 S' Floor X = $ <br /> 2"d FIOo� X - $ <br /> e Garage X - $ <br /> �': � Z� <br /> ; <br /> Estimated Construction Value: � �r �--- <br /> Orono Inspections Required Work Requiring Separate Permits <br /> r: Footing ❑ Site ❑ Plumbing � Grading/Filling <br /> ❑ Poured Wall 0 Si►t Fence/Erasion Control ❑ Mechanical � Fire <br /> ❑ Foundation Survey ❑ Hardcover Removal 0 Septic ❑ Water Connection <br /> � 0 Foundation Waterproofing ❑ Other(specify) ❑ Fireplace ❑ Sewer Connection <br /> �$ �Framing � Masonry 0 Lawn Irrigation <br /> U Q Insulation � Mfg. ❑ Landscaping <br /> G;., <br /> � ❑ As-Built Survey 0 Other(specify) <br /> �` �Final <br /> �- 0 Lathe Required State Permits <br /> � Other(specify) <br /> � Well ❑ Electrical <br /> �, <br /> � <br /> � REMARKS (in-house): <br /> � <br /> � <br /> ,, <br /> � <br /> � <br /> a OFFICIAL REMARKS -TO BE NOTED ON PERMlT AND INITIALLED: <br /> �, ~'0..�eE�tter��ci�t�w�dgerr�ert#Fo►�� �� <br /> � <br /> t <br /> � ,�Pri�to release of escrow money ac�,a.srb�lt���a�d-hard6ou�a4�lat+e�s-m�s�-be-submi#ted-and a�proved. <br /> { F '��, -ef `�S„" R�+' f �E �•�'k���e���� � Ef�t` .k�l'*' �'�- ��t r�f€'ff ��,14" � f`— �A'��E,-�F;a kd�� a <br /> i <br /> t <br /> + Updated: October 2015 <br /> �•\fnrmc\nlan ravio�ni rharkliel 'I fl_9f11 F rinrv <br />