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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> • <br /> Permit Number: ❑ Yes 0 No 0 N/A ❑ Yes 0 <br /> ❑ Yes ❑ No 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 ❑ No ❑ Yes ❑ No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit <br /> Plan Review (/1 <br /> State Surcharge t:/` <br /> Investigation Fee tom' <br /> SAC— Number of SAC Units V <br /> Other(specify) C.-- <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1St Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> m0 <br /> Estimated Construction Value: $ 3 , 9O <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing 0 Site Plumbing 0 Grading /Filling <br /> ❑ Poured Wall 0 Silt Fence/Erosion Control )3[ Mechanical 0 Fire <br /> ❑ Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection <br /> ❑ Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection <br /> Framing 0 Masonry 0 Lawn Irrigation <br /> 5Et" Insulation 0 Mfg. 0 Landscaping <br /> ❑ As-Built Survey 0 Other(specify) <br /> yft Final <br /> ❑ Lathe Required State Permits <br /> ❑ Other(specify) <br /> 0 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 /> r\fnrmc\nlan rouicIni rharklict 1n_9n1c rinry <br />