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Shoreland District MCWD Permit Average Lakeshore Setback 'Bluff <br /> Met? <br /> � Yes � No Permit Number: 0 Yes 0 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 /> � Yes � No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit <br /> Plan Review i,� <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 S� Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> /�. ,,p :� <br /> Estimated Construction Value: $ `7' 0��VG� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing � Site Plumbing � Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control Mechanical � Fire <br /> 0 Foundation Survey � Hardcover Removal � Septic � Water Connection <br /> � 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 /> 0 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 rcvio�ei nc�rklict 1(1_9(115 rinrv <br />