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Average Lakeshore Setback <br /> 3horeland District MCWD Permit Met? Bluff <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 � No 0 Yes � 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 (/� <br /> Other(specify) L` <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> 2nd FIOOr X = $ <br /> Garage X = $ <br /> ,/ / p �9 l <br /> Estimated Construction Value: $ 7(2(�, (yv(� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site xPlumbing ❑ Grading/ Filling <br /> 0 Poured Wall ❑ Silt Fence/Erosion Control Mechanical ❑ Fire <br /> � Foundation Survey 0 Hardcover Removal ❑ Fireplace ❑ Water Connection <br /> 0 Framing � Other(specify) � Masonry 0 Sewer Connection <br /> � Waterproofing/Drain tile ❑ Mfg. 0 Lawn Irrigation <br /> � Foundation Waterproofing � Other(specify) � Landscaping <br /> �ffi Framing <br /> Insulation <br /> ❑ As-Built Survey <br /> Final <br /> 0 Lathe Required State Permits <br /> ❑ Other(specify) <br /> � Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> 0 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 />