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Shoreland District MCWD Permit Average Lakeshore Setback Bluf# ' <br /> M et? <br /> ❑ Yes ❑ No Permit Number: 0 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 � Yes 0 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 j�" <br /> SAC—Number of SAC Units � <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 15� Floor X = $ <br /> 2"d FIoO� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ /�, ( `��_� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site 0 Plumbing ❑ Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control ❑ Mechanical 0 Fire <br /> 0 Foundation Survey � Hardcover Removal 0 Septic 0 Water Connection <br /> 0 Foundation Waterproofing ❑ Other(specify) � Fireplace � Sewer Connection <br /> Framing ❑ Masonry � Lawn Irrigation <br /> � Insulation 0 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 /> 0 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 /> Updated: October 2015 <br /> �•\fnrmc\nlan ravic�ni rharlrlic4 1(1_9f11F rinrv <br />