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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> � Yes No <br /> Permit Number: l� .. � Yes 0 No N/A � Ye 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 � Yes o <br /> 1 2 3 4 5 ��l�'J�iM Type�s�. Type�S�. <br /> l./Y �I <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) <br /> Square Foota e $ per Square Footage <br /> Basement f �� x �(���� _ $ Z L ,z8 <br /> 1 St Floor �f�?. X �(�7Q. � _ $ Z . �- <br /> �4�"�t��yG �v� -�n�5�o ��j�Q z, X � �=� _ $ � ,�,. C � <br /> Garage �(- � '�/QZ'j c� X = $ Jr 0�` o0 <br /> Estimated Construction Value: $ LU(/ l, % ( � �� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing � Site Plumbing � Grading/ Filling <br /> Poured Wall Silt Fence/Erosion Control Mechanical � Fire <br /> Foundation Survey � Hardcover Removal Fireplace � Water Connection <br /> 0 Framing ❑ Other(specify) 0 Masonry ❑ Sewer Connection <br /> � Waterproofing/Drain tile �Mfg. 0 Lawn Irrigation <br /> �Foundation Waterproofing 0 Other(specify) � Landscaping <br /> Framing <br /> " Insulation <br /> As-Built Survey <br /> � Final <br /> � Lathe Required State Permits <br /> 0 Other(specify) <br /> W ell Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> See Builder Acknowledgement Form <br /> � rior 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 />