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Average Lakeshore Setback • <br /> Shoreland District MCWD Permit Met? Bluff <br /> � Yes 0 No Permit Number: 0 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 /> � 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 <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 Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ (y���t/ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing 0 Site Plumbing � Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control Mechanical 0 Fire <br /> 0 Foundation Survey 0 Hardcover Removal � Septic � Water Connection <br /> � oundation Waterproofing � Other(specify) � Fireplace 0 Sewer Connection <br /> Framing 0 Masonry 0 Lawn Irrigation <br /> Insulation � Mfg. � Landscaping <br /> � As-Built Survey � Other(specify) <br /> Final <br /> � Lathe 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 /> 0 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 raviow nc�r4licT 1(1_9MF rinrv <br />