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J' • • <br /> Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> � Yes 0 No Permit Number: � 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 /> 0 Yes 0 No � Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Perm it C./� <br /> Plan Review <br /> State Surcharge � <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 /> 2nd FIOo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ / �� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site 0 Plumbing � Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control ❑ Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal � Septic 0 Water Connection <br /> � Foundation Waterproofing � Other(specify) 0 Fireplace � Sewer Connection <br /> � Framing 0 Masonry 0 Lawn Irrigation <br /> � Insulation 0 Mfg. 0 Landscaping <br /> � As-Built Survey � Other(specify) <br /> Final <br /> 0 athe Required State Permits <br /> � Other(specify) <br /> ❑ Well 0 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 ravia�u rhorklicf'I fl_9(11 F rinrr <br />