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Shoreland District MCWD Permit Average Lakeshore Setback Blufif ' <br /> Met? <br /> 0 Yes � No Permit Number: 0 Yes 0 No 0 N/A � Ye 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 /> 0 Yes � No � Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Perm it � <br /> Plan Review l� <br /> State Surcharge <br /> Investigation Fee <br /> SAC—Number of SAC Units U <br /> Other(specify) <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 15� Floor X = $ <br /> 2nd FIOo� X = $ <br /> Garage X = $ <br /> m �� <br /> Estimated Construction Value: $ �ly� ��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing � Site Plumbing 0 Grading/Filling <br /> � Poured Wall ❑ Silt Fence/Erosion Control Mechanical 0 Fire <br /> � Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection <br /> � Foundation Waterproofing 0 Other(specify) 0 Fireplace � Sewer Connection <br /> Framing � Masonry � Lawn Irrigation <br /> Insulation � Mfg. 0 Landscaping <br /> � As-Built Survey 0 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 /> 0 See Builder Acknowledgement Form <br /> 0 Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �•\fnrmc\nlan rovic�ei rharlrliet 1f1_9(11F rinrv <br />