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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes � No Permit Number: � Yes � No 0 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 °/a and sf % and sf <br /> � Yes � No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit v <br /> Plan Review � <br /> State Surcharge (/' <br /> Investigation Fee � <br /> SAC—Number of SAC Units I/ <br /> Other(specify) <br /> Square Footage $ per Square Foota e <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> 2nd FIoO� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �. ,�i �� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site � Plumbing 0 Grading/Filling <br /> 0 Poured Wall ❑ Silt Fence/Erosion Control � Mechanical 0 Fire <br /> ❑ Foundation Survey � Hardcover Removal 0 Septic 0 Water Connection <br /> � Foundation Waterproofing 0 Other(specify) 0 Fireplace � Sewer Connection <br /> Framing � Masonry � Lawn Irrigation <br /> 0 Insulation � Mfg. ❑ Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> inal <br /> � Lathe Required State Permits <br /> � Other(specify) <br /> � Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> 0 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 ro�iio�ni rhorklict 1f1_7!1'IF rinrv <br />