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'� Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> � Yes � No Permit Number: � Yes � No 0 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 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> ` <br /> Fees to be Char ed YES NO <br /> 4" Permit <br /> Plan Review !/ <br /> State Surcharge f/' <br /> Investigation Fee <br /> � SAC—Number of SAC Units <br /> Other(specify) (/� <br /> Square Foota e � er S uare Foota e <br /> Basement X = $ <br /> 1 S� Floor X = $ <br /> 2� Floor X = $ <br /> ' Garage X = $ <br /> 2�y�y� �-- <br /> Estimated Construction Value: $ 1�(%(�(J <br /> � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site ❑ Plumbing ❑ Grading/Filling <br /> ❑ Poured Wall ❑ Silt Fence/Erosion Control � Mechanical � Fire <br /> ❑ Foundation Survey 0 Hardcover Removal ❑ Septic ❑ Water Connection <br /> � Foundation Waterproofing 0 Other(specify) ❑ Fireplace ❑ Sewer Connection <br /> Framing ❑ Masonry ❑ Lawn Irrigation <br /> � Insulation � Mfg. ❑ Landscaping <br /> ❑ As-Built Survey ❑ Other(specify) <br /> Final <br /> � Lathe Required State Permits <br /> ❑ Other(specify) <br /> � 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 /> �: <br /> Updated: October 2015 <br /> �•\fnrmc\nlan ravio�ei nc�rklict 1f1_9(115 rin�v <br />