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Shoreland District MCWD Permit Average Lakeshore Setback glur` <br /> Met? <br /> Permit Number: � Yes � No � N/A � Yes � <br /> 0 Yes � No 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 0 No � Yes � 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 <br /> State Surcharge (� <br /> Investigation Fee �` <br /> SAC—Number of SAC Units ��� " (f <br /> Other(specify) <br /> Square Foota e $ er Square Foota e <br /> Basement �'�(1 X J(,�, y = $ <br /> 1 St Floor X = $ <br /> 2nd FI0o1' X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ � �, �t,Y� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site Plumbing ❑ Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control Mechanical 0 Fire <br /> � Foundation Survey � Hardcover Removal � Septic � Water Connection <br /> � Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection <br /> raming � Masonry 0 Lawn Irrigation <br /> Insulation � Mfg. � Landscaping <br /> � As-Built Survey 0 Other(specify) <br /> �Final <br /> � Lathe Required State Permits <br /> 0 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 /> 0 Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: October 2015 <br /> �•\fnrme\nlan rcvia�ei nc�eklic4'I(1_9f11 F flnrv <br />