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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> � Met? <br /> Permit Number: � Yes � No • 0 N/A 0 Yes � <br /> � Yes � No No <br /> � 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 0 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 Foota e $ per Square Footage <br /> Basement X = $ <br /> 1 S� Floor X = $ <br /> 2nd FIOOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �,��D <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing � Site 0 Plumbing 0 Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control 0 Mechanical ❑ Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic 0 Water Connection <br /> � Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> Framing � Masonry 0 Lawn Irrigation <br /> 0 Insulation ❑ Mfg. 0 Landscaping <br /> � As-Built Survey � Other(specify) <br /> Final <br /> 0 Lathe Required State Permits <br /> � 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 /> �or to release of escrow money . <br /> Q 7'�ll� i!t n�— C,Q�'C.00-� 4 ib-e�-- <br /> �� v <br /> Updated: October 2015 <br /> r\fnrmc\nlan ravia�u rharklict 1!1_9(19 F rVnrv <br />