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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> � Yes � No Permit Number: ❑ Yes � No � 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 /> 0 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 (f <br /> State Surcharge j,� <br /> Investigation Fee <br /> SAC— Number of SAC Units <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 S� Floor X = $ <br /> 2nd FlOor X = $ <br /> Garage X = $ <br /> 7 ✓ <br /> Estimated Construction Value: $ ,�, ��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing ❑ Site 0 Plumbing 0 Grading/ Filling <br /> � Poured Wall � Silt Fence/Erosion Control 0 Mechanical O Fire <br /> 0 Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection <br /> � Foundation Waterproofing 0 Other(specify) ❑ Fireplace 0 Sewer Connection <br /> Framing � � Masonry ❑ Lawn Irrigation <br /> 0 Insulation " " r�u`Q a�✓Q ❑ Mfg. 0 Landscaping <br /> 0 As-Built Survey ❑ Other(specify) <br /> �Final <br /> 0 Lathe Required State Permits <br /> 0 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 /> 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 ravia�ni rhar4licf 1h_9f19F rinrv <br />