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-,�,.>,�:�„F.- . _ �.,��.:�a�,�-,,��.�u,,.��; , . . , .. ����� <br /> � <br /> �' Average Lakeshor�Setback � <br /> Shoreland District MCWD Permit �et� Bluff <br /> � � Yes 0 No Permit Number: 0 Yes 0 No 0 N/A � Ye No � <br /> � � N/A—see attached Setback: <br /> f <br /> e <br /> ; Stormwater Qualit Existin Pro osed <br /> s Y 9 P <br /> ?' Overlay District Tier Hardcover Hardcover Variance Required CUF Required <br /> f- circle one % and sf % and sf <br /> � 0 Yes � No � Yes � No <br /> �; 1 2 3 4 5 Type(s): Type(s): <br /> � <br /> � - <br /> �. Fees to be Char ed YES NO <br /> � P�rmit �'` <br /> � �lan t��view t/ <br /> � State Surcharge �,,,./" <br /> � Investigation Fee l/� <br /> �, <br /> � S,4C—Number of SAC Linits {�� <br /> = Other(specify) �� <br /> � <br /> €' <br /> S uare Foota e $ per S uare Foota e <br /> �; Basement X = $ <br /> � 1 St Floor X = $ <br /> � <br /> �- 2nd Floor X = $ <br /> � Garage X = $ <br /> 1 <br /> � <br /> � Estimated Gonstruction Value: $ l �i��� <br /> �,: <br /> � <br /> � Orono Inspections Required Work Requiring Separate Permits <br /> €° <br /> �' � Footing � Site Plumbing � Grading/Filling <br /> �`. � Poured Wall � Silt Fence/Erosion Control Mechanical � Fire <br /> ` � Foundation Survey � Hardcover Removal � eptic � Water Connection <br /> ; <br /> �;, 0 Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> � Framing ❑ Masonry � Lawn Irrigation <br /> ��` Insulation � Mfg. � Landscaping <br /> 0 As-Built Survey � Other(specify) <br /> e � Final <br /> � 0 Lathe Reguired State Permits <br /> � Other(specify) <br /> k° � Well Electrical <br /> r <br /> k <br /> e <br /> � REMARKS (in-house): <br /> � <br /> � <br /> # <br /> �:; OFFICIAL REMARKS -TO BE NQTED ON RE�MIT AND INITIALLED: <br /> t � See �uilder Acknowledgement�orm <br /> «: <br /> � <br /> �. 0 Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> �' <br /> F <br /> _: Updated: October 2015 <br /> ,: <br /> �� �•\fnrmc\nlan ravio�ni rhacklict 9(1_9M5 rinev <br />