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Shoreland District MCWD Permit Average Lakeshore Setback B <br /> Met? <br /> � Yes � No Permit Number: 0 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 /> � 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 Foota e <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> 2nd FIOOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: l `—� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing � Site Plumbing 0 Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control �Mechanical ❑ Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic 0 Water Connection <br /> � Foundation Waterproofing � Other(specify) 0 Fireplace 0 Sewer Connection <br /> Framing � Masonry � Lawn Irrigation <br /> Insulation 0 Mfg. ❑ Landscaping <br /> � As-Built Survey ❑ Other(specify) <br /> Final <br /> 0 Lathe Required State Permits <br /> 0 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 ravio�ei rharklict 1(1_9MF rinrv <br />