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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? . <br /> � Yes � No Permit Number: ❑ Yes � 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 � 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 <br /> State Surcharge v <br /> Investigation Fee 1/' <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 /> 2nd FlOor X = $ <br /> Garage X = $ <br /> Q �y� � <br /> Estimated Construction Value: $ C1� i�I Y1 1 <br /> �v <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing � Site Plumbing ❑ Grading/ Filling <br /> � Poured Wall ❑ Silt Fence/Erosion Control Mechanical � Fire <br /> 0 Foundation Survey � Hardcover Removal 0 Septic ❑ Water Connection <br /> 0 Foundation Waterproofing � Other(specify) � Fireplace ❑ Sewer Connection <br /> Framing � Masonry � Lawn Irrigation <br /> 0 Insulation � Mfg. � Landscaping <br /> � As-Built Survey ❑ Other(specify) <br /> Final <br /> � 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 ravio�ni rhorklicT 1!1_7(11 F rinrr <br />