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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes � No Permit Number: 0 Yes 0 No ❑ N/A � Ye No � <br /> 0 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 0 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 Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FloOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site Plumbing � Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control Mechanical ❑ Fire <br /> 0 Foundation Survey ❑ Hardcover Removal ❑ Septic � Water Connection <br /> � Foundation Waterproofing ther(specify) 0 Fireplace ❑ Sewer Connection <br /> Framing �,fl� ❑ Masonry � Lawn Irrigation <br /> ❑ Insulation ��y � 0 Mfg. ❑ Landscaping <br /> � As-Built Survey ❑ Other(specify) <br /> �Final <br /> 0 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 ra�iia�u rharklict 1f1_7h1F rinrv <br />