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a...: .m.+.�:e auei�-.=,.�..�,.., �,xaxiY+... .+n,:.•w.�...we-c.Y �..e-.e.:.... ��w�^tw:.m...._.rqym..F.�. �.�a.... .:K`"�r.� _ ., . .-. , z .. . . �`�v�P"'. .- .,i . <br /> Shoreland District MC1I1lD Rermit Average Lakeshore Setback B��ff <br /> MeY? <br /> Permit Number: � Yes � No � N/A 0 Yes 0 <br /> ❑ Yes � No No <br /> ❑ N/A—see attached Setback: <br /> Stormwater Quality Existing Proposed <br /> Overiay 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 Char ed YES NO <br /> Perr�it s <br /> Ptan Review <br /> State Surcharge :/� <br /> � Investigation Fee E <br /> SAC—Number of SAC Units a.� <br /> � Other(specify) °� <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 9` <br /> 15t Floor X = $ <br /> 2nd Fdoor X = $ <br /> ` Garage X = $ <br /> Estimated Construction Value: � ��� <br /> , <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing ❑ Site �Plumbing � Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control Mechanical ❑ Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic 0 Water Connection <br /> ' ❑ Foundation Waterproofing � Other(specify) 0 Fireplace 0 Sewer Connection <br /> 4 �Framing � Masonry � Lawn Irrigation <br /> fnsulation ❑ Mfg. ❑ Landscaping <br /> � As-Built Survey ❑ Other(specify} <br /> Final <br /> ❑ Lathe Required State Permits <br /> � Other(specify) <br /> ❑ Weli Electrical <br /> i:. <br /> REMARKS (in-house): <br /> OFFICl�iL RENiARKS -TO BE IVOTED (�N RERMlT AND INITIALLED: <br /> :' ❑ See Builder Acknowledgement Form <br /> � Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �.�F........�..I.... .............Mn..Llia-��/l 7l11F rinrv <br />