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� , , , <br /> Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> � Yes � No Permit Number: �Yes 0 No 0 N/A � Ye No � <br /> � N/A–see attached , Setback: <br /> , ,- <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 /> Permit (�-' <br /> Plan Review L <br /> State Surcharge <br /> Investigation Fee �- <br /> SAC– Number of SAC Units <br /> Other(specify) (�/ <br /> Square Foota e $ per Square Footage <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> 2nd FIOo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ ( 7 �=)J�— <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site � Plumbing 0 Grading/ Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control 0 Mechanical ❑ Fire <br /> � Foundation Survey � Hardcover Removal � Septic � Water Connection <br /> � Foundation Waterproofing � Other(specify) � Fireplace 0 Sewer Connection <br /> �Framing � Masonry ❑ Lawn Irrigation <br /> 0 Insulation � Mfg. � Landscaping <br /> � As-Built Survey � 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 /> � 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 ravic�u rhorklict 1f1_7(11F rinrv <br />