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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? . <br /> 0 Yes � <br /> � Yes 0 No Permit Number: 0 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 � 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 Footage $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FIoOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ lQ���� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site Plumbing � Grading/Filling <br /> � Poured Wall ❑ Silt Fence/Erosion Control � Mechanical 0 Fire <br /> 0 Foundation Survey ❑ Hardcover Removal 0 Fireplace � Water Connection <br /> � Framing 0 Other(specify) 0 Masonry 0 Sewer Connection <br /> � Waterproofing/Drain tile � Mfg. � Lawn Irrigation <br /> 0 Foundation Waterproofing � Other(specify) � Landscaping <br /> Framing <br /> Insulation <br /> 0 As-Built Survey <br /> Final <br /> � Lathe Required State Permits <br /> 0 Other(specify) <br /> 0 Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> � 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 />