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Average Lakeshore Setback <br /> Shoreland District MCWD Permit Met? Bluff <br /> � Yes p No Permit Number: � Yes � 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 /> � Yes � 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 �,/ <br /> State Surcharge �/ <br /> Investigation Fee �/ <br /> SAC—Number of SAC Units � <br /> Other(specify) <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �nd� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing � Site 0 Plumbing 0 Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control � Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal � Fireplace � Water Connection <br /> � Framing 0 Other(specify) 0 Masonry 0 Sewer Connection <br /> ❑ Waterproofing/Drain tile � Mfg. 0 Lawn Irrigation <br /> O Foundation Waterproofing � Other(specify) 0 Landscaping <br /> Framing <br /> � Insulation <br /> 0 As-Built Survey <br /> inal <br /> � Lathe Required State Permits <br /> � Other(specify) <br /> � Well 0 Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> 0 See Builder Acknowledgement Form <br /> � Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />