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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes 0 No Permit Number: 0 Yes 0 No � N/A � Ye No � <br /> O 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 � Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plan Review l/ <br /> State Surcharge V <br /> Investigation Fee t/ <br /> SAC— Number of SAC Units <br /> Other(specify) � <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FIoO� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ � �, ��0 � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site �Plumbing 0 Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control ❑ Mechanical � Fire <br /> � Foundation Survey 0 Hardcover Removal � Septic 0 Water Connection <br /> � Foundation Waterproofing 0 Other(specify) � Fireplace � Sewer Connection <br /> �Framing 0 Masonry 0 Lawn Irrigation <br /> ❑ Insulation 0 Mfg. ❑ Landscaping <br /> � As-Built Survey � Other(specify) <br /> Final <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 /> O 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 fP\/IPU/rharklict 1(1_9l11F rinrv <br />