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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> "`�Yes 0 No Permit Number: � � -�� l�, �Yes 0 No � N/A � Ye Na <br /> J � ❑ 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 /> ��•�pq07c� � �.l 7 O�p � Yes No � Yes No <br /> � 2 3 4 5 o► r <br /> 43Z0.�'F ��lG� �1" TYPe�s)� TYpe(s): <br /> Fees to be Char ed YES NO <br /> Permit v <br /> Plan Review <br /> State Surcharge l/` <br /> Investigation Fee <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Footage $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> �0 <br /> Estimated Construction Value: $ �9 ��D <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site � Plumbing � Grading/Filling <br /> 0 Poured Wall ❑ Silt Fence/Erosion Control � Mechanical ❑ Fire <br /> � Foundation Survey � Hardcover Removal � Fireplace ❑ Water Connection <br /> � Framing 0 Other(specify) � Masonry � Sewer Connection <br /> 0 Waterproofing/Drain tile � Mfg. � Lawn Irrigation <br /> ❑ Foundation Waterproofing O Other(specify) ❑ Landscaping <br /> Framing <br /> � Insulation <br /> As-Built Survey <br /> nal <br /> 0 Lathe Required State Permits <br /> � Other(specify) <br /> 0 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 />