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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> 0 Yes � No 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 /> 0 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 <br /> Plan Review <br /> State Surcharge <br /> Investigation Fee <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Foota e $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> � <br /> Estimated Construction Value: $ �� � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site ❑ Plumbing 0 Grading/ Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical � Fire <br /> ❑ Foundation Survey 0 Hardcover Removal 0 Septic ❑ Water Connection <br /> 0 Foundation Waterproofing �Other(specify) 0 Fireplace ❑ Sewer Connection <br /> Framing ❑ Masonry 0 Lawn Irrigation <br /> 0 Insulation ��r�u�' ��9s 0 Mfg. ❑ Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> Final <br /> � Lathe Required State Permits <br /> 0 Other(specify) <br /> 0 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 rcvic�ni rharklicf 9(1_9h1F rinrv <br />