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Shoreland District MCWD Permit Average Lakeshore Setback g�uff � <br /> Met? <br /> 0 Yes p Na 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 /> � Yes 0 No 0 Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit tf <br /> Plan Review � <br /> State Surcharge � <br /> Investigation Fee (/' <br /> SAC— Number of SAC Units 1/� <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 15t Floor X = $ <br /> 2nd FIOOr X = $ <br /> Garage X = $ <br /> 0�, v� <br /> Estimated Construction Value: $ Cll,��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing ❑ Site � Plumbing � Grading/ Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control 0 Mechanical ❑ Fire <br /> � Foundation Survey ❑ Hardcover Removal ❑ Septic ❑ Water Connection <br /> ❑ Foundation Waterproofing �Other(specify) ❑ Fireplace ❑ Sewer Connection <br /> 0 Framing �n ��� ��.���- ❑ Masonry � Lawn Irrigation <br /> ❑ Insulation 0 Mfg. ❑ Landscaping <br /> � As-Built Survey ❑ Other(specify) <br /> Final <br /> ❑ Lathe Required State Permits <br /> � Other(specify) <br /> � Well 0 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 rovio�u rharlrlict 9(1_7(11F rinrv <br />