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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes � No Permit Number: � Yes 0 No 0 N/A � Ye 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 /> � Yes 0 No � 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) V— <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 15f Floor X = $ <br /> 2"d FI00� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ / `/. Lyl y' l,l <br /> e�—. <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing ❑ Site Plumbing � Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control Mechanical � Fire <br /> 0 Foundation Survey ❑ Hardcover Removal � Septic � Water Connection <br /> 0 Foundation Waterproofing ❑ Other(specify) � Fireplace � Sewer Connection <br /> �Framing 0 Masonry 0 Lawn Irrigation <br /> Insulation ❑ Mfg. 0 Landscaping <br /> � As-Built Survey ❑ Other(specify) <br /> �Final <br /> � 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 /> 0 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 ravia�u rharklicf 1(1_�(11F rinrv <br />