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L ' <br /> Shoreland District MCWD Permit Average Lakeshore Setback g�uff � <br /> Met? <br /> � Yes , 0 <br /> � Yes � No Permit Number: � Yes 0 No 0 N/A 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 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 �/" <br /> State Surcharge � <br /> Investigation Fee c/` <br /> SAC—Number of SAC Units `-'' <br /> Other(specify) �f <br /> Square Footage $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: 0 <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site �Plumbing � Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control Mechanical 0 Fire <br /> � Foundation Survey � Hardcover Removal � Fireplace � Water Connection <br /> 0 Framing � Other(specify) � Masonry � Sewer Connection <br /> ❑ Waterproofing/Drain tile 0 Mfg. 0 Lawn Irrigation <br /> � Foundation Waterproofing 0 Other(specify) 0 Landscaping <br /> Framing <br /> Insulation <br /> � As-Built Survey <br /> Final <br /> 0 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 /> 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 /> !/' !^ `>" !� �(Q'�/ �" ta l Y <br /> T 7� i^ i fi� � m C G vl � C`�m Wl <br /> Updated: May 2016 �/J� �, � ,�/ <br /> z:\forms\plan review checklist 5-2016.docx /"� �(�t� G' � <br />