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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 �O� <br /> � Site <br /> Escrow Amount 0 Hardcover Removal <br /> � Footing <br /> Escrow Agreement received? � Poured Wall <br /> 0 As-Built Survey <br /> � Yes 0 No � Planting Plan <br /> 0 Wetland Buffer <br /> Escrow Money received? � Final <br /> 0 Yes � No 0 Other(specify) <br /> Engineering review needed? <br /> 0 Yes � No <br /> ,/ • /_ <br /> REMARKS (in-house): I lJ <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\old stufflplan review checklist for zoning permit applications 2013.docx <br />