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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> M et? <br /> � Yes � � <br /> � Yes ❑ No Permit Number: 0 Yes 0 No � N/A Na <br /> 0 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 /> 0 Yes ❑ No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit (�' <br /> Plan Review <br /> State Surcharge (�' <br /> Investigation Fee � � <br /> SAC— Number of SAC Units <br /> Other(specify) (/-, <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 15t Floor X = $ <br /> 2�d FI00� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ f f/, ��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing � Site �lumbing ❑ Grading/ Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control � Mechanical 0 Fire <br /> ❑ Foundation Survey � Hardcover Removal ❑ Septic � Water Connection <br /> � Foundation Waterproofing � Other(specify) ❑ Fireplace � Sewer Connection <br /> Framing 0 Masonry O Lawn Irrigation <br /> �Insulation ❑ Mfg. � Landscaping <br /> � As-Built Survey ❑ Other(specify) <br /> Final <br /> 0 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 /> � 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 ravia�u rharlrlict 9(1_9(11ri rinrv <br />