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Shoreland District MCWD Permit Average Lakeshore Setback Bluff� <br /> Met? <br /> 0 Yes 0 No Permit Number: � Yes 0 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 /> 0 Yes 0 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 t/ <br /> Plan Review <br /> State Surcharge �� <br /> Investigation Fee (� <br /> SAC—Number of SAC Units t/' <br /> Other(specify) � <br /> Square Foota e $ per Square Footage <br /> Basement X = $ <br /> 1 S� Floor X = $ <br /> 2nd FIOo� X = $ <br /> Garage X = $ <br /> _i <br /> Estimated Construction Value: � i <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site �Plumbing 0 Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control � Mechanical � Fire <br /> 0 Foundation Survey 0 Hardcover Removal 0 Septic � Water Connection <br /> 0 Foundation Waterproofing � Other(specify) 0 Fireplace � Sewer Connection <br /> �Framing � Masonry � Lawn Irrigation <br /> � Insulation � Mfg. � Landscaping <br /> 0 As-Built Survey � Other(specify) <br /> Final <br /> 0 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 /> 0 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 ravia�ei rharklict 1(1_9(11�i rinrv <br />