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� Shoreland District MCV'JQ Permit average Lakeshore Setback B��ff <br /> ' Met? <br /> Permit Number: �� _ Yes ❑ No � N/A � Yes <br /> �Yes � No No <br /> � N/A-see attached Setback: <br /> Stormwater Quality Existing Proposed <br /> Overtay District Tier Hardcover Hardcover Variance Required CUP Required <br /> circle one % and sf % and sf <br /> �-� ��,'�'� L� tt�.,���(� Yes � No CI Yes No <br /> ( 1�/ 2 3 4 5 !^��.�� (' �.��� S� TYPe�s). n�W tidtWR Type(s): . <br /> `�• � 'I�, � i �` <br /> ��}to <br /> Fees to be Char ed YES NO <br /> Perm it ��` <br /> Plan Review �' <br /> State Surcharge <br /> Investigation Fee �°` <br /> SAC-Number of SAC Units '�,,r � <br /> Other(specify) � <br /> Square Foota e $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo►' X = $ <br /> Garage X = $ <br /> F �� y ���` <br /> Estimated Construction Vaiue: ��� � ��"� <br /> � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing ❑ Site � �Plumbing ❑ Grading/Fiiling <br /> �; � Poured Wall Silt Fence/Erosion Control + Mechanical � Fire <br /> � !7 Foundation Survey � Hardcover Removat 0 Septic ❑ Water Connection <br /> �' Foundation Waterproofing � Other(specify) Fireplace ❑ Sewer Connection <br /> �`' Framing ❑ Masonry ❑ Lawn Irrigation <br /> Insulation ��vlfg. ❑ Landscaping <br /> As-Built Survey ❑ Other(specify) <br /> Final <br /> Lathe Required State Rermits <br /> � JOther(specify) <br /> Well Electrical <br /> ` & <br /> REMARKS (in-house): � 6� �� �6 � � �� `�� ��- ���` �`- Eo'�� ' <br /> ! <br /> I <br /> � <br /> � OFFIClAL REM�4.k�66� -TO BE NOl'ED ON PERMiT AN� INITlA�LE�: <br /> � <br /> I Se i �emen orm <br /> � �Prior to release of escrow money an as-built survey and hardcover calculations must be ubmitted and approved. <br /> i � �� ��Q6 � �� � ` <br /> I • .� i.� ��,� <br /> �� � <br /> t <br /> i Updated: October 2015 <br /> `. �•\fnrmc\nlan rovio�u�hnr4lict 1(1_9(11�i rinrv <br />