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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 13 Yes 13 No Permit Number: 13Yes 13No 13N/A 13 Yes <br /> Ell <br /> 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 ❑ Yes ❑ No <br /> 1 2 3 # 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit V <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 /> 1st Floor X = $ <br /> 2nd Floor X $ <br /> Garage X _ $ <br /> Estimated Construction Value: $ , <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing ❑ Site Plumbing ❑ Grading/Filling <br /> ❑ Poured Wall ❑ Silt Fence/Erosion Control Mechanical ❑ Fire <br /> ❑ Foundation Survey ❑ Hardcover Removal ❑ Septic ❑ Water Connection <br /> ❑ Foundation Waterproofing ❑ Other(specify) ❑ Fireplace ❑ Sewer Connection <br /> Framing ❑ Masonry ❑ Lawn Irrigation <br /> ❑ Insulation ❑ 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 /> ❑ See Builder Acknowledgement Form <br /> ❑ 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\n1an ravia l rharlrlici 10-901 F rinry <br />