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Average Lakeshore Setback —� <br /> Shoreland District MCWD Permit Met? Bluff <br /> 0 Yes � No Permit Number: � Yes 0 No 0 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 /> 0 Yes 0 No ❑ 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 /> 15t Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ ���� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site ❑ Plumbing � Grading/Filling <br /> ❑ Poured Wall ❑ Silt Fence/Erosion Control 0 Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic � Water Connection <br /> � Foundation Waterproofing � Other(specify) 0 Fireplace 0 Sewer Connection <br /> �Framing � Masonry ❑ Lawn Irrigation <br /> � Insulation 0 Mfg. 0 Landscaping <br /> � As-Built Survey � Other(specify) <br /> 1�Final <br /> �0 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 /> 0 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 ravia�u rhar4lict 1 fl_9f11 F rinrv <br />