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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> M et? <br /> 0 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 /> � 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 1/ <br /> Investigation Fee <br /> SAC— Number of SAC Units <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 S� Floor X = $ <br /> 2"d FIo01' X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ J -I ., ��� , <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site 0 Plumbing � Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control 0 Mechanical � Fire <br /> � Foundation Survey 0 Hardcover Removal � Septic 0 Water Connection <br /> 0 Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> 'Framing � Masonry 0 Lawn Irrigation <br /> Insulation � Mfg. ❑ Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> Final <br /> 0 Lathe Required State Permits <br /> � Other(specify) <br /> O Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> � 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�ni rhnrklie}1(1_7l11F finrv <br />