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. <br /> Shoreland District MCWD Permit Average Lakeshore Setback g;uff <br /> Met? <br /> � Yes � No Permit Number: � Yes 0 No 0 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 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 �1/' <br /> Other(specify) (_/' <br /> Square Footage $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FIOOr X = $ <br /> Garage X = $ <br /> �� <br /> Estimated Construction Value: $ 1�� d�� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ❑ Footing ❑ Site Plumbing � Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control Mechanical � Fire <br /> � Foundation Survey ❑ Hardcover Removal �Fireplace ❑ Water Connection <br /> 0 Framing ❑ Other(specify) � Masonry � Sewer Connection <br /> 0 Waterproofing/Drain tile �Mfg. � Lawn Irrigation <br /> ❑ Foundation Waterproofing � Other(specify) � Landscaping <br /> raming <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 /> 0 See 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 />