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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> Permit Number: � Yes � No � N/A � Yes 0 <br /> � Yes 0 No No <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 /> 0 Yes 0 No � Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plan Review �/ <br /> State Surcharge �' <br /> Investigation Fee (,/� <br /> SAC–Number of SAC Units L/' <br /> Other(specify) �- <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> ,� _� <br /> Estimated Construction Value: $ �(�/,(� D <br /> —�r_ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing ❑ Site � Plumbing 0 Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control � Mechanical � Fire <br /> 0 Foundation Survey ❑ Hardcover Removal � Fireplace 0 Water Connection <br /> 0 Framing ❑ Other(specify) � Masonry 0 Sewer Connection <br /> 0 Waterproofing/Drain tile � Mfg. 0 Lawn Irrigation <br /> � Foundation Waterproofing � Other(specify) ❑ Landscaping <br /> Framing <br /> Insulation <br /> 0 As-Built Survey <br /> Final <br /> � Lathe Required State Permits <br /> � Other(specify) <br /> 0 Well 0 Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> � 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 />