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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: 0 Yes � No 0 N/A 0 Yes � <br /> � Yes � 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 °/o and sf % and sf <br /> � 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 <br /> Other(specify) <br /> Square Footage $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FIOo� X = $ <br /> Garage X = $ <br /> � �'' � , �..�- <br /> /� i <br /> Estimated Construction Value: $ ) (i <br /> Orono Inspections Required Work Requiring Separate Permits <br /> , �L '.5�Cl�' � � Site 0 Plumbing 0 Grading/Filling <br /> �C ��d.F � Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> �'rt��!r,V'_f _�S � Hardcover Removal ❑ Fireplace � Water Connection <br /> � Other(specify) � Masonry � Sewer Connection <br /> 1e ❑ Mfg. 0 Lawn Irrigation <br /> � ,��'�1�� �� _ � Other(specify) 0 Landscaping <br /> ,... / <br /> Final <br /> 0 Required State Permits <br /> � � <br /> 0 Well 0 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 />