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Average Lakeshore Setback <br /> Shoreland District MCWD Permit Met? Bluff <br /> � Yes No Permit Number: l _ 0 Yes 0 No �N/A � Ye No <br /> � <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 /> • 0 Yes No 0 Yes No <br /> 1 2 3/� )Q� 5 �� �ro � � Type(s): Type(s): <br /> � .. � , <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 Floo� X = $ <br /> Garage X = $ <br /> /L o..� <br /> Estimated Construction Value: $ 'I ��,�� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site Plumbing � Grading/Filling <br /> Poured Wall Silt Fence/Erosion Control Mechanical 0 Fire <br /> Foundation Survey 0 Hardcover Removal � Fireplace �Water Connection <br /> �Framing ❑ Other(specify) � Masonry Sewer Connection <br /> Waterproofing/Drain tile Mfg. 0 Lawn Irrigation <br /> Foundation Waterproofing Other(specify) � Landscaping <br /> Framing <br /> Insulation <br /> As-Built Survey <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 /> � 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 />