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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Yes No Permit Number: 0 Yes 0 No 0 N/A 0 Yes <br /> CI No 0 <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 0 Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit t,., <br /> Plan Review (/' <br /> State Surcharge <br /> Investigation Fee V <br /> SAC--Number of SAC Units l7 <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1St Floor X = $ <br /> 2nd Floor X = $ <br /> Garage f X = $ <br /> Estimated Construction Value: $ / iI/ 0IY0 <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site 0 Plumbing 0 Grading/Filling <br /> O oured Wall 0 Silt Fence/Erosion Control Mechanical 0 Fire <br /> O Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection <br /> O Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> O Framing 0 Masonry 0 Lawn Irrigation <br /> O Insulation 0 Mfg. 0 Landscaping <br /> O As-Built Survey 0 Other(specify) <br /> Final <br /> O Lathe Required State Permits <br /> 1 er(sp Ify) <br /> G•-Hor I 0 Well 4,X Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> O 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 /> 7•\fnrmc\nlan ratiicw rharklict 1n_9f is rinry <br />