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Shoreland District MCWD Permit Average Lakeshore Setback Bluf� <br /> Met? <br /> �Yes � No Permit Number: � Yes 0 No N/A � Ye 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 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 Foota e $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: �(J�V �` <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site 0 Plumbing 0 Grading/Filling <br /> Poured Wall � Silt Fence/Erosion Control 0 Mechanical ❑ Fire <br /> � Foundation Survey � Hardcover Removal � Septic 0 Water Connection <br /> � Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> � Framing � Masonry � Lawn Irrigation <br /> 0 nsulation � 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 /> 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 /> r\fnrmc\nlan rovio�u rhor4lie}1(1_9f11F`inrr <br />