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�.���� s,�..w�...�_._..�, ,.:,.,� .�_r,._.,__ �.�.� _._.�..,_-__�..:.�.--_. __ , _ . _ _ <br /> Shoreland District MCVVa Permit Average Lakeshore Setback Bluff <br /> M et? <br /> � <br /> 0 Yes 6� No Permit Number: � Yes 0 No � N/A � Ye 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 /> , <br /> E: <br /> Fees to be Char ed YES NO <br /> � Permit ':��'"' <br /> ! <br /> � Plan Review � <br /> ` State Surcharge t�:�� <br /> � Investigation Fee <br /> � <br /> � �AC- Number of SAC Units �,;�" <br /> � Other(specify) r,s'� <br /> i <br /> �` Square Foata e $ per Square Footage <br /> Basement X = $ <br /> �`. 1 St Floor X = $ <br /> a <br /> � 2nd Floo� X = $ <br /> , <br /> � Garage X = $ <br /> � <br /> � <br /> �` Estimated Construction �+alue: $ �'e _.��� <br /> �. <br /> � . Orono lnspections Required Work Requiring Se�arate Permits <br /> t <br /> � <br /> i ❑ Footing 0 Site Q Plumbing ❑ Grading/Filling <br /> � ❑ Poured Wall � Silt Fence/Erosion Control ❑ Mechanical ❑ Fire <br /> �, ❑ Foundation Survey � Hardcover Removal ❑ Septic � Water Connection <br /> �� ❑ Foundation Waterproofing 0 Other(specify) ❑ Fireplace ❑ Sewer Connection <br /> ; <br /> � ,Framing � Masonry � Lawn Irrigation <br /> � Insulation ❑ Mfg. ❑ Landscaping <br /> ❑ As-Built Survey� ❑ Other(specify) <br /> � Final <br /> Q Lathe Requirec! State Permits <br /> ;- <br /> 0 Other(specify) r <br /> ❑ Well Electrical <br /> � > <br /> REfl�EiRKS (in-house): <br /> OFFIClAL REM/�RKS -TO BE NOTED ON PERNi1T AND INITIALLED: <br /> �' ❑ See Builder Rcknowledgement 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 /> r\fnrmc\nlan rovia�ni nc�rklic4 1f1_9MF rinrv <br />