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r <br /> Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Yes D No Permit Number: 0 Yes 0 No 0 N/A 0 Yes <br /> 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 /> D Yes 0 No D Yes O No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit (/ <br /> Plan Review dr ✓. <br /> State Surcharge ✓ • <br /> Investigation Fee <br /> SAC—Number of SAC Units 1,-- <br /> Other <br /> /Other(specify) 1Z <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1st Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X -� = $ <br /> / <br /> Estimated Construction Value: $ I,; ) 7c0 <br /> / <br /> Orono Inspections Required Work Requiring Separate Permits <br /> O Footing 0 Site 0 Plumbing 0 Grading/Filling <br /> O Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> O Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection <br /> O Foundation Waterproofing Other(specify) 0 Fireplace 0 Sewer Connection <br /> O Framing foe 551,CO 5./- 0 Masonry 0 Lawn Irrigation <br /> O Insulation 0 Mfg. 0 Landscaping <br /> O As-Built Survey 11.eC h 6 U(5/1 .4,1 0 Other(specify) <br /> XFinal �' ff <br /> 0 Lathe Required State Permits <br /> O Other(specify) <br /> 0 Well 0 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 /> r\fnrme\nlan raviauei rharldief l n_9r11 c rinry <br />