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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes 0 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 D No D Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit <br /> Plan Review t/f <br /> State Surcharge L.-, <br /> Investigation Fee (� <br /> SAC—Number of SAC Units t/r <br /> Other(specify) t - <br /> Square Footage $ per Square Footage <br /> Basement zi- x l'_ 50 = $ 4i (e(20 <br /> 1St Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ ‘OO <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 ControlMechanical 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 /> Framing 0 Masonry 0 Lawn Irrigation <br /> nsulation 0 Mfg. 0 Landscaping <br /> O As-Built Survey D Other(specify) <br /> Final <br /> O Lathe Required State Permits <br /> O Other(specify) <br /> 0 Well 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 raviCMA/rhorklict 1(_9)81c rinry <br />