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Shoreland District MCWD Permit Av rage Lakeshore Setback gluff <br /> Met? <br /> Yes 0 No Permit Number: Yes � No � N/A � Ye No <br /> 0 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 /> Yes � No � Yes <br /> 1 2 3 4 5 �L.�.'�r�j 2)�-E-, (o`Ld Tt�� )�,�� S i r�-r TYPe�S)• <br /> �f' t,o <br /> � <br /> Fees to be Char ed YES NO <br /> Permit � <br /> Plan Review �' <br /> State Surcharge <br /> Investigation Fee 1/' <br /> SAC—Number of SAC Units �/`� <br /> Other(specify) � <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 15t Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> /� �''� <br /> Estimated Construction Value: $ % ��0� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �,Footing 0 Site 0 Plumbing ❑ Grading/Filling <br /> ❑ Poured Wall Silt Fence/Erosion Control � Mechanical � Fire <br /> ❑ Foundation Survey � Hardcover Removal � Fireplace � Water Connection <br /> ❑ Framing 0 Other(specify) � Masonry � Sewer Connection <br /> � Waterproofing/Drain tile O Mfg. � Lawn Irrigation <br /> � Foundation Waterproofing 0 Other(specify) � Landscaping <br /> �.Framing <br /> �0 Insulation <br /> As-Built Survey <br /> inal <br /> Lathe Required State Permits <br /> 0 Other(specify) <br /> ❑ Well 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 /> � �t"��'� (f SV r✓�� Ve��w(�d �-�c���� esC-�� �1z �� <br /> (� C�t��I�S� � J�.v� r�u,l�-G b Y�o Y' ��ct--I �1 �� <br /> Updated: M y 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />