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Earth Movement-Cubic Yards <br /> In Out Total <br /> Haul Route? ? 0 Yes 0 No <br /> Explain haul route in detail: <br /> Fees to be Charged Amount Orono Inspections Required <br /> Permit Fee Amount <br /> 0 Site <br /> Escrow Amount 0 Hardcover Removal <br /> 1D 0 Footing <br /> Escrow Agreement received? 0 Poured Wall <br /> 0 As-Built Survey <br /> "(Yes 0 No 0 Planting Plan <br /> 0 Wetland Buffer <br /> Escrow Money received? C3ff(inal <br /> Yes 0 No 0 Other(specify) <br /> Engineering review needed? <br /> )I,(es 0 No <br /> REMARKS (in-house): <br /> Other Review: Reviewed by: Date Approved: <br /> REMARKS(TO BE NOTED ON PERMIT AND INITIALLED ply, PERSON PULLING PERMIT) <br /> bas\ c �,4-cd �- wt �(. iI uki e�- arm) Kaki Q 12 <br /> -e:� iQ[i3 i e ViAdati(A(`-- <br /> Updated:January 2013 <br /> z:\fomis\plan review checklist for zoning permit applications 2013.docx <br />