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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> � Yes 0 No Permit Number: � Yes � No ❑ 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) <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FIOo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ [�(i ��v�_ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site ❑ Plumbing � Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control 0 Mechanical O Fire <br /> 0 Foundation Survey 0 Hardcover Removal � Septic 0 Water Connection <br /> 0 Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> Framing � Masonry � Lawn Irrigation <br /> Insulation 0 Mfg. 0 Landscaping . <br /> � As-Built Survey � Other(specify) <br /> Final <br /> 0 La he Required State Permits <br /> 0 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 rovio�ni rhorklic4 4(1_9f11ri rinrv <br />