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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Yes � No Permit Number: _?��� 0 Yes No � N/A � Ye No <br /> ✓ <br /> � N/A-see attached ��� etback: <br /> Stormwater Quality Existing Proposed <br /> Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> circle one % and sf % and sf <br /> Yes 0 No 0 Yes No <br /> � 2 3 4 5 Type(s): Type(s): <br /> ,�__ t � <br /> �'U�� <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 Foota e <br /> Basement / f �e� �p/ X 14•S� _ $ � ? <br /> 15� Floor SsLf- X �OQ, _ $ � lf, pL�, <br /> ,GP�ks �3 SO X ��•S� _ $ / 5`Z. SO <br /> Garage f� �,Q X �•�(p = $ �z, �� <br /> �- <br /> Estimated Construction Value: $ ,� �z ,�� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site Plumbing 0 Grading/Filling <br /> � Poured Wall Silt Fence/Erosion Control �Mechanical 0 Fire <br /> 0 Foundation Survey ❑ Hardcover Removal Fireplace 0 Water Connection <br /> ❑ Framing 0 Other(specify) � Masonry � Sewer Connection <br /> 0 Waterproofing/Drain tile �.Mfg. � Lawn Irrigation <br /> � Foundation Waterproofing ❑ Other(specify) ❑ Landscaping <br /> Framing <br /> Insulation <br /> � As-Built Survey <br /> inal <br /> 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 r e a ardcover calcul � itted and approved. <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />