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: > g.� -�'�*' s; <br /> Average Lakeshore Setback <br /> Shoreland District MCWD Permit �et� Bluff , <br /> C7 Yes No P���t Number: � ^ (,� 0 Yes � No N/A � Ye�o <br /> � � N/A—see attached Setback: <br /> Stormwater Quatity Existing Proposed <br /> Overlay District Tter Hardcover Hardcover Variance Required CUP Required <br /> circle one % and s % and s <br /> 0 Yes No 0 Yes No <br /> 1 2 3 4 5 ���f/� ----� Type{s): Type{s): <br /> �i `b <br /> Fees to be Char ed YES NO <br /> Fertnit l/ <br /> Plan Review �/` <br /> Sta�e Surcha,rge (/' r ,_ <br /> Investigation Fee 1/ <br /> � SAG—Nuinber of SAC Unets , _ 1/` ; <br /> Other(specify) <br /> i <br /> S uare Foota e $ er S uare Foota e , <br /> Basement j X �, ,G, _ , $ Z/�' <br /> 1n Floor � . X = $ �j� �� .�Q <br /> � 2nd Floot' X QQ� _ $ � � � , � <br /> Garage X ,� � _ $ � <br /> Estimated Construction Va{ue: $ ����_��j <br /> Orono Inspections Required Work Requiring Separate Permits � <br /> `� <br /> Footing � Sife (umbing ❑ Grading/Fi{iing , <br /> Poured Wall Silt Fence/Erosion Controf Mechanica! C7 Fire <br /> Foundation Survey L7 Hardcover Ramoval 0 Septic � Water Connection <br /> Foundation Waterproofing ❑ Other(specify} Frceplace ❑ Sewer Connection <br /> Framing ❑ Masonry � Lawn irr+gafion <br /> {nsulation �A€g. ❑ Landscaping <br /> As-Buitt Survey �Other(specify} <br /> Final <br /> , � Lathe Required Stafe Permits <br /> , _ - <br /> 4 O Ofher(specify) <br /> � Welt Eleetrical <br /> �, <br /> � <br /> � REMARKS (in-house): <br /> f <br /> � <br /> k <br /> � <br /> f <br /> � �: <br /> ! OF ICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: - `'` }k .� <br /> i See Buifde . Acknowledgement Form <br /> � o releas of esc ey an as- ' rv calcul � . <br /> { <br /> � <br /> f <br /> I. <br /> ; <br /> , <br /> F <br /> � Updated: October 2015 . <br /> r\fnrmclnl�n ro�iiAw rhorklict 1(L9M�,rinrr -. ` <br /> - . �• <br />