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Shoreland District MCWD Permit Average Lakeshore Setback Bluff ' <br /> Met? <br /> . Permit Number: _ Z Yes ❑ No 0 N/A � Ye No <br /> es � 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 /> � Z.S ,�E�'�",��, 0 Yes No 0 Yes <br /> � 2 3 4 5 � T�� �r TYPe�s): Type(s): <br /> � <br /> j `;; `:�, -,)r'� �L, ri 1 � . <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 Footage $ per Square Footage <br /> Basement X - $ <br /> 1 S' Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> / /' /� /�y� t <br /> Estimated Construction Value: $ /1 (p�V,UTA./ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing ❑ Site Plumbing � Grading/Filling <br /> Poured Wall Silt FenceJErosion 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. ❑ Lawn Irrigation <br /> Foundation Waterproofing � Other(specify) 0 Landscaping <br /> Framing <br /> Insulation <br /> � As-Built Survey <br /> Final <br /> I 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 />