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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> � Yes � No Permit Number: 0 Yes 0 No 0 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 /> � Yes 0 No � Yes � No <br /> 1 2 3 � 5 - � � TYp�(S)� . TYPe(s)� <br /> Fees to be Char ed YES NO <br /> Perm it <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 /> O <br /> Estimated Construction Value: $ �� ��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site Plumbing 0 Grading/Filling <br /> O Poured Wall � Silt Fence/Erosion Control Mechanical � Fire <br /> � Foundation Survey ❑ Hardcover Removal 0 Fireplace 0 Water Connection <br /> 0 Framing � Other(specify) 0 Masonry 0 Sewer Connection <br /> 0 Waterproofing/Drain tile � Mfg. � Lawn Irrigation <br /> � Foundation Waterproofing � Other(specify) � Landscaping <br /> Framing <br /> Insulation <br /> � As-Built Survey <br /> Final <br /> 0 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 /> 0 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 />