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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes No Permit Number: ❑ Yes 0 No ,&N/A 0 <br /> YesNo <br /> )( <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 /> a‘knpl <br /> ❑ Yes <br /> " No ❑ Yes jNo <br /> 1 2 3 4 5Type(s): ' Type(s): <br /> Fees to be Charged 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 Footage <br /> Basement X = $ <br /> 1st Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> eh <br /> Estimated Construction Value: $ 3(°/©VO <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site 0 Plumbing 0 Grading/Filling <br /> O Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> O Foundation Survey 0 Hardcover Removal 0 Fireplace 0 Water Connection <br /> O Framing 0 Other(specify) 0 Masonry 0 Sewer Connection <br /> O Waterproofing/Drain tile 0 Mfg. 0 Lawn Irrigation <br /> O Foundation Waterproofing 0 Other(specify) 0 Landscaping <br /> )C Framing <br /> /❑ Insulation <br /> As-Built Survey <br /> inal <br /> O Lathe Required State Permits <br /> O Other(specify) <br /> 0 Well 0 Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> )2(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 />