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Shoreland District MCWD Permit Average Lakeshore Setback Bluff+ � <br /> M et? <br /> � Yes � No Permit Number: � 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 0 No � Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit � <br /> Plan Review <br /> State Surcharge �' <br /> Investigation Fee v` <br /> SAC— Number of SAC Units (/ <br /> Other(specify) <br /> Square Foota e $ per Square Footage <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ ���'�'t/ ~ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing ❑ Site Plumbing 0 Grading/Filling <br /> ❑ Poured Wall 0 Silt Fence/Erosion Control Mechanical 0 Fire <br /> 0 Foundation Survey � Hardcover Removal � Septic 0 Water Connection <br /> 0 Foundation Waterproofing �Other(specify) Fireplace 0 Sewer Connection <br /> Framing ��' '',� J� Z,� �� �� ❑ Masonry � Lawn Irrigation <br /> Insulation ��� � �Mfg. ❑ Landscaping <br /> � As-Built Survey 5C� (�� ❑ 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 /> � 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 /> �•lfnrmc\nlan rovio�ni rhor41ie4 1f1_9MF rinrv <br />