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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> M et? <br /> �Yes 0 No Permit Number: 15 _ Yes � No � N/A � Ye 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 /> �,5�6 �(p.q�'p 0 Yes o � Yes � o <br /> Q 2 3 4 5 �g,� �� �� �� Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit � <br /> Plan Review � <br /> State Surcharge 't/—" <br /> Investigation Fee �/' <br /> SAC– Number of SAC Units <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> _ �, <br /> .--,,{�/(`�� r1 ��c, <br /> Estimated Construction Value: $ �7�%'V, ���/ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing ❑ Site Plumbing 0 Grading/ Filling <br /> � Poured Wall Silt Fence/Erosion Control � Mechanical 0 Fire <br /> � Foundation Survey � Hardcover Removal 0 Septic � Water Connection <br /> .Foundation Waterproofing ❑ Other(specify) Fireplace � Sewer Connection <br /> Framing 0 Masonry 0 Lawn Irrigation <br /> �Insulation �Mfg. � Landscaping <br /> 0 As-Built Survey 0 Other(specify) <br /> r Final <br /> Lathe Required State Permits <br /> � Other(specify) <br /> � Well Electrical <br /> REMARKS (in-house): 3��CJ Z7�0� <br /> Ph �oUc.r.3�,� � �. ,: c �� _ <br /> �u ou�s�U►�. .y,b�;�rWprK . <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> �See Builder Acknowledgement Form <br /> scrow an as- � approved. <br /> Updated: October 2015 <br /> . ��\fnrmc\nlan rcvia�u rhar41ic4'I fl_9(11 F rinrv <br />