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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Yes f] No Permit Number: 0 Yes 0 No N/A 0 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 /> X4,"1 Q� l(p,ZSb 0 Yes No 0 Yes No <br /> 1 Ito, <br /> 2 3 4 5 Type(s): Type(s): <br /> 3gq sf <br /> Fees to be Charged YES NO <br /> Permit L'__� <br /> Plan Review (/ <br /> State Surcharge �- <br /> Investigation Fee <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 s' Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X � _ $ <br /> © <br /> Estimated Construction Value: $ LY} !,©yo <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site 0 Plumbing 0 Grading/Filling <br /> 0 Poured Wall XSilt Fence/Erosion Control 0 Mechanical 0 Fire <br /> Q ,Foundation Survey 0 Hardcover Removal 0 Fireplace 0 Water Connection <br /> 0 Framing 0 Other(specify) 0 Masonry 0 Sewer Connection <br /> 0 Waterproofing/Drain tile 0 Mfg. 0 Lawn Irrigation <br /> 0 Foundation Waterproofing 0 Other(specify) 0 Landscaping <br /> PFraming <br /> ED<31nsulation <br /> 0 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 /> 0 See Builder Acknowledgement Form <br /> %X 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 />