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Earth Movement- Cubic Yards <br /> In Out Total <br /> Haul Route? ? D Yes 0 No <br /> Explain haul route in detail: <br /> Fees to be Charged Amount Orono Inspections Required <br /> Permit Fee Amount /5C) <br /> 0 Site <br /> Escrow Amount 0 Hardcover Removal <br /> r k L' ❑ Footing <br /> 0 <br /> Escrow Agreement received? C.r/W/ 0 As-Built <br /> Wall <br /> .° lt Survey <br /> O Yes o c l (ii/ 0 Planting Plan <br /> PQ°C) 0 Wetland Buffer <br /> Escrow Money received? � '1"l +nal <br /> O Yes No �(�t <br /> 11 0 Other(specify) <br /> Engineering review needed? ! ' <br /> /ties D No <br /> REMARKS (in-house): <br /> Other Review: Reviewed by: Date Approved: <br /> REMARKS (TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PALING PERMIT) <br /> 1 re�Q ezciinto ylAgNAr 15faa -&- IN121240 - rNyeer . <br /> CAi9W of L arm e Mr 10 Sd ba) U <br /> Updated:January 2013 <br /> z:\forms\plan review checklist for zoning permit applications 2013.docx <br />