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. ... 'r^ffi�ar�r..'�s�as$.Tcca�:a:��' �-.�.uu s.��: ,_. �,., � ....t ' _ ' _ <br /> w . � .-,.,,�.�... ,�.-.<nW:.... ...-.,� ....._.. .._..�...:n..�,_.� <br /> , �_- . .�•. ..-., . .,. . ., . ,- . . . .. .._._..� _ .__ ._ . <br /> , �.. . , _ ... ,r.. . ...._ . .._. *�5 <br /> . .. . . . ... �� :�.,.� �`°E <br /> t <br /> � Average Lakeshore Setback " <br /> � Shoreland District MCWD Permit Met? Biuff <br /> � <br /> � ❑ Yes 0 No Permit Number. � Yes � No � N/A � Ye No � °; <br /> � <br /> �, � N/A-see attached Setback: ' <br /> �x <br /> Stormwater Quality Existing Proposed <br /> Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> circle one % and sf % and sf <br /> ;� <br /> � Yes ❑ No ❑ Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> F <br /> � Fees to be Char ed YES NO <br /> � Permit <br /> Plan Review <br /> State Surcharge t/` <br /> Investigation Fee <br /> SAC-Number of SAC Units l/� <br /> Other(specify) �� <br /> Square Footage $ per Square Foota e <br /> Basement X = $ <br /> 1 S� Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> /� .�-� <br /> Estimated Construction Value: $ 7 � �oo <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing ❑ Site ❑ Plumbing ❑ Grading /Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control ❑ Mechanical � Fire <br /> ❑ Foundation Survey O Hardcover Removal ❑ Septic � Water Connection <br /> 0 Foundation Waterproofing ❑ Other(specify) ❑ Fireplace � Sewer Connection <br /> -f �Framing ❑ Masonry 0 Lawn Irrigation <br /> � Insulation 0 Mfg. ❑ Landscaping <br /> � As-Built Survey ❑ Other(specify) <br /> Final <br /> ❑ Lathe Required State Permits <br /> ❑ Other(specify) <br /> 0 Well � Electrical <br /> REMARKS (in-house): <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 ravia�ni rhar4lict 1f1_)(11F r7nrv <br />