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Earth Movement-Cubic Yards <br /> In Out Total <br /> Haul Route? ? ❑ Yes ❑ No <br /> Explain haul route in detail: <br /> Fees to be Charged Amount Orono Inspections Required <br /> Perna Fee Amount <br /> 0 Site <br /> Escrow Amount 0 Hardcover Removal <br /> 111300 ❑ Footing <br /> Escrow Agreement received? ❑ Poured Wall <br /> 0 As-Built Survey <br /> 0 No 0 Planting Plan <br /> / ❑ Wetland Buffer <br /> Escrow Money received? Einal <br /> / 0 Other(specify) <br /> ¢'Yes 0 No <br /> Engineering review needed?/ <br /> "Kies 0 No <br /> REMARKS (in-house): CL& 2-14o C 1 f L I <br /> Other Review: Reviewed by: Date Approved: <br /> REMARKS (TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT) <br /> Updated:January 2013 <br /> z:\forms\plan review checklist for zoning permit applications 2013.docx <br />