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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: � Yes 0 No � N/A 0 Yes 0 <br /> 0 Yes 0 No 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 /> 0 Yes � No 0 Yes ❑ No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit �/' <br /> Plan Review v- <br /> State Surcharge I/' <br /> Investigation Fee l� <br /> SAC-Number of SAC Units V <br /> Other(specify) l/� <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> 2�d FI0o1' X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ � �i�� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing 0 Site 0 Plumbing � Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical ❑ Fire <br /> 0 Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection <br /> 0 Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> Framing � Masonry � Lawn Irrigation <br /> Insulation ❑ Mfg. � Landscaping <br /> � As-Built Survey 0 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 />� 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 />��\fnrmc\nlan rovia�u rharklict 1 fl_9(19 F rinrv <br />