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Average Lakeshore Setback <br /> Shoreland District MCWD Permit Met? Bluff <br /> � Yes � No Permit Number: 0 Yes � 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 � No � Yes � No <br /> 1 2 3 4 5 Type(s):° Type(s): <br /> Fees to be Char ed YES NO <br /> Prarmit <br /> Plan Review �/ <br /> State Surc�ar�e <br /> Investigation Fee <br /> 6A�.=Nurr�ber of SAC Unit"s <br /> Other(specify) (/ <br /> S uare Foota e $ er Square Foota e <br /> Basement X = $ <br /> 1�Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: V � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site Plumbing � Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control 0 Mechanical � Fire <br /> 0 Foundation Survey 0 Hardcover Removal 0 Septic � Water Connection <br /> � Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> �Framing � Masonry 0 Lawn Irrigation <br /> �Insulation � Mfg. 0 Landscaping <br /> 0 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 /> � Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �•\fnrme\nlan raviAui rthor4lic}1(1_9f115 rinrr <br />