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, ,.s. _.. ._,,, ,, ...,,w . .. . .-_ , _s,. a . , <br /> Average Lakeshore Setback <br /> g Shoreland District MCWD Permit Met? Biuff <br /> Yes � No Permit Number: � Yes � No N/A � Ye Na <br /> � N/ 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 � Yes No <br /> 1 2 3 4 5 (� ,/� , n t Type(s): Type(s): <br /> �\)</ � .� <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plan Review <br /> State Surcharge <br /> r :,:., '. <br /> Investigation Fee <br /> �,, , SAC-Number of SAC Units <br /> Other(specify) � <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 15t Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: �� ��D ��- <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site ❑ Plumbing � Grading/Filling <br /> ❑ Poured Wall � Silt Fence/Erosion Control ❑ Mechanical 0 Fire <br /> ❑ Foundation Survey 0 Hardcover Removal 0 Septic � Water Connection <br /> ❑ Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> �Framing 0 Masonry 0 Lawn Irrigation <br /> � Insulation ❑ Mfg. � Landscaping <br /> 0 As-Built Survey ❑ Other(specify) <br /> Final <br /> ❑ Lathe Required State Permits <br /> " � Other(specify) <br /> � Well ❑ Electrical <br /> REMARKS (in-house): <br /> �; <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> ' er Ackno rm <br /> �Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> V � <br /> � <br /> Updated: October 2015 <br /> �•\fnrmc\nlan ravinw rharlrlict 1(1_9MF rinrv <br />