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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> M et? <br /> 0 Yes 0 No Permit Number: � Yes � No 0 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 � No � 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 " <br /> State Surcharge <br /> Investigation Fee (� <br /> SAC—Number of SAC Units (/' <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FIOOr X = $ <br /> Garage X = $ <br /> /�� �i <br /> Estimated Construction Value: $ �T�� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing 0 Site ❑ Plumbing ❑ Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical � Fire <br /> ❑ Foundation Survey 0 Hardcover Removal 0 Septic ❑ Water Connection - <br /> ❑ Foundation Waterproofing ❑ Other(specify) ❑ Fireplace 0 Sewer Connection <br /> �Framing ❑ Masonry ❑ Lawn Irrigation <br /> Insulation 0 Mfg. ❑ Landscaping <br /> � As-Built Survey ❑ Other(specify) <br /> Final <br /> ❑ Lathe Required State Permits <br /> 0 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 rcvia�ei rharklicf 1(1_9f11ri rinrr <br />