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Shoreland District MCWD Permit Average Lakeshore Setback Bluff . <br /> M et? <br /> � Yes 0 No Permit Number: 0 Y�s � 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 /> � Yes � 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 j/' <br /> State Surcharge <br /> Investigation Fee <br /> SAC— Number of SAC Units �/' <br /> Other(specify) f/—� <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ ��, �(�� <br /> o.� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing ❑ Site Plumbing 0 Grading/Filling <br /> ❑ Poured Wall ❑ Silt Fence/Erosion Control Mechanical ❑ Fire <br /> ❑ Foundation Survey ❑ Hardcover Removal 0 Septic � Water Connection <br /> ❑ Foundation Waterproofing � Other(specify) � Fireplace ❑ Sewer Connection <br /> Framing ❑ Masonry � Lawn Irrigation <br /> Insulation �.; Mfg. 0 Landscaping <br /> � As-Built Survey 0 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 ravic�ei rharlrlict 1(1_9(11 F rinrv <br />