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Shoreland District MCWD Permit Average Lakeshore Setback g�uff ' <br /> , Met? <br /> Permit Number: � Yes � No 0 N/A � Yes � <br /> � Yes � No 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 � No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Perm it <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 Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: �s 77 —� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing � Site � Plumbing 0 Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic � Water Connection <br /> � Foundation Waterproofing Other(specify) 0 Fireplace ❑ Sewer Connection <br /> Framing v�df���,��� �Q/,�I� 0 Masonry � Lawn Irrigation <br /> ❑ Insulation �� � O Mfg. 0 Landscaping <br /> 0 As-Built Survey � Other(specify) <br /> Final <br /> 0 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 /> r\fnrmc\nlan ro�iia�ei nc�rklic4 1f1_9(11F rinrr <br />