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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> � Yes No Permit Number: � 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 /> � Yes No � Yes o <br /> 1 2 3 4 5 ��(P� Type(s): Type(s): <br /> P` �'l <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 X = $ � <br /> 1 St Floor X = $ <br /> 2nd FIOo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �- 1( <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing 0 Site � Plumbing 0 Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> ❑ Foundation Survey � Hardcover Removal 0 Fireplace � Water Connection <br /> 0 Framing � Other(specify) � Masonry 0 Sewer Connection <br /> 0 Waterproofing/Drain tile O Mfg. � Lawn Irrigation <br /> ❑,Foundation Waterproofing � Other(specify) 0 Landscaping <br /> Framing <br /> �Insulation <br /> As-Built Survey <br /> Y <br /> Final <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 /> �ee Builder Acknowledgement Form <br /> 0 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 />