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Average Lakeshore Setback <br /> Shoreland District MCWD Permit Met? Bluff <br /> � Yes 0 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 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Perm it <br /> Plan Review Z/' <br /> State Surcharge <br /> Investigation Fee i/� <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Foota e $ per Square Foota e <br /> ' Basement X = $ <br /> 1 S' Floor X = $ <br /> 2nd FIOOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �-����� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site Plumbing 0 Grading/Filling <br /> ❑ Poured Wall � Silt Fence/Erosion Control Mechanical � Fire <br /> 0 Foundation Survey � Hardcover Removal � ireplace � Water Connection <br /> 0 Framing 0 Other(specify) 0 Masonry 0 Sewer Connection <br /> O Waterproofing/Drain tile 0 Mfg. � Lawn Irrigation <br /> � Foundation Waterproofing � Other(specify) � Landscaping <br /> ' Framing <br /> ° �Insulation <br /> 0 As-Built Survey <br /> Final <br /> � Lathe Required State Permits <br /> � Other(specify) <br /> � Well Electrical <br /> i <br /> ;: <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> 0 See Builder Acknowledgement Form <br /> 0 Prior to release of escrow money an as-built survey and hardcover calculaiions must be submitted and approved. <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />