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_,.,�.,.�._.-�-..-�.<.� .�....�� ..,..--�-r-;�:-��.-�--�-�-�- ,-�- �; - �-� _- - _- <br /> Shoreland District MCWD Permit � _� Average Lakr�eet ore Setback ��uff <br /> _�,-�, „., ❑ Yes ❑ <br /> 0 Yes � No Permit Number: "��� ���`� 0 Yes � No 0 N/A No <br /> 0 N/A—see attached Setback: <br /> Stormwater Quality Existing Prop��ecf <br /> Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> circle one % and sf % and sf <br /> � Yes 0 No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> $ <br /> 5;; Fees to be Char ed YES NO <br /> Permit <br /> " Plar� Redie�nr `�/ <br /> ; <br /> State Surcharge �< <br /> Investigation Fee <br /> SAC—Number of SAC Units �` <br /> � Other(specify) �/ <br /> 4 <br /> �quare Footage $ per Square Footage <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> 2nd FIOOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: � ��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing � Site Plumbing � Grading/Filling <br /> 0 Poured Wall ❑ Silt Fence/Erosion Control Mechanical 0 Fire <br /> „ O Foundation Survey 0 Hardcover Removal � Septic � Water Connection <br /> � Foundation Waterproofing 0 Other(specify) ❑ Fireplace � Sewer Connection <br /> ` Framing 0 Masonry � Lawn Irrigation <br /> �Insulation ❑ 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 /> OF�ICIAL R�lVI�lRKS -TO �E NOTED ON PERMIT AND INITI�4LLED: <br /> � See Builder Acknowledgement 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 /> ��\fnrmc\nlan rcvic�ni�harklict 9(1_9f11F rinrv <br />