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��t �� � ' �'.� �, �'���„ . <br /> Average Lakeshore Setback <br /> �, Shoreland District MCWD Permit Met? Bluff <br /> Yes� 0 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 /> l�.Z� ��{,�Q � Yes No 0 Yes No <br /> 1 2 � 4 5 A_ C � ���� Type(s): Type(s): <br /> �C J <br /> Fees to be Char ed YES NO <br /> Perm it <br /> Plan Review <br /> State Surcharge <br /> Investigation Fee <br /> SAC—Number of SAC Units �(/' <br /> Other(specify) <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FloOt' X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ � �D^ <br /> v <br /> Orono Inspections Required Work Requiring Separate Permits <br /> 0 Footing 0 Site 0 Plumbing ❑ Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control � Mechanical 0 Fire <br /> � Foundation Survey ❑ Hardcover Removal � Fireplace 0 Water Connection <br /> � Framing ❑ Other(specify) � Masonry � Sewer Connection <br /> 0 Waterproofing/Drain tile ❑ Mfg. 0 Lawn Irrigation <br /> ❑ Foundation Waterproofing 0 Other(specify) � Landscaping <br /> �Framing <br /> 0 Insulation <br /> s-Built Survey <br /> Final <br /> ❑ Lathe Required State Permits <br /> 0 Other(specify) <br /> � Well ❑ Electrical <br /> REMARKS (in-house): <br /> OFF CIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALL � �.z � j^0 U �(� (/� <br /> �� Y <br /> ee Builder Acknowledgement Form �f C / /'( A, C a� ��� <br /> Prior to release of escrow money an as-built survey and hardcover calculations must e submitted and approved. <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />