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� <br /> Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> 0 Yes � No Permit Number: � Yes 0 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 /> � Yes ❑ No � Yes ❑ No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged 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 Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2"d Floo� X = $ <br /> Garage X = $ <br /> / ,� � <br /> Estimated Construction Value: $ / �l/ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing ❑ Site ❑ Plumbing ❑ Grading/ Filling <br /> 0 Poured Wall ❑ Silt Fence/Erosion Control ❑ Mechanical ❑ Fire <br /> 0 Foundation Survey � Hardcover Removal � Septic � Water Connection <br /> ❑ Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> � Framing 0 Masonry ❑ Lawn Irrigation <br /> ❑ Insulation ❑ Mfg. � Landscaping <br /> � As-Built Survey 0 Other(specify) <br /> Final <br /> ❑ Lathe Required State Permits <br /> ❑ Other(specify) <br /> ❑ Well 0 Electrical <br /> REMARKS (in-house): <br /> � / <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: ��<<,�'� ��C�U��S t�I � (�/�'���`f'� IP <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 ravia�ni rhorlrlic}9(1_9f19F rinrv <br />