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Aver.age Lake ore Setback ' � <br /> Sh�oreland District MCWD Permit _ . , . ��� . - BI'uff <br /> � Yes � No Permit Number: 0 Yes O 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 0 Yes � 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 Footage $ per Square Foota e <br /> Basement X = $ <br /> 15f Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site ❑ Plumbing 0 Grading/ Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic 0 Water Connection <br /> � Foundation Waterproofing � Other(specify) 0 Fireplace � Sewer Connection <br /> Framing 0 Masonry 0 Lawn Irrigation <br /> Insulation � Mfg. 0 Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> Final <br /> � Lathe Required State Permits <br /> 0 Other(specify) <br /> � Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INIT�ALLED: <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 /> �•lfnrmc\nlan ravic�u rharklict 1f1_7f11F rinrv <br />