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Average Lakeshore Setback <br /> Shoreland District MCWD Permit Met? Bluff <br /> Yes ❑ No Permit Number: (� ^ �70 � Yes � No N/A � Ye No <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 /> r"�� ' � Yes No � Yes No <br /> lb-���1 �..� II��� �6 <br /> � 2 3 4 5 , ,� , � . � �7� �� `v� TYPe�S)• Type(s)• <br /> ',0�-�~'-�� <br /> Fees to be Char ed YES NO <br /> Perm it t/ <br /> Plan Review (�` <br /> State Surcharge (/' <br /> Investigation Fee 4/' <br /> SAC—Number of SAC Units (/� <br /> Other(specify) <br /> Square Footage $ per Square Foota e <br /> Basement X = $ <br /> 1 S� Floor X = $ , <br /> 2nd FIOOr • X = $ • <br /> Garage X = $ <br /> Estimated Construction Value: $ ,�7,�,��� � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site Plumbing ❑ Grading/Filling <br /> oured Wall Silt Fence/Erosion Control Mechanical � Fire <br /> ❑ Foundation Survey � Hardcover Removal � Fireplace � Water Connection <br /> � Framing 0 Other(specify) 0 Masonry ❑ Sewer Connection <br /> � Waterproofing/Drain tile 0 Mfg. � Lawn Irrigation <br /> � Foundation Waterproofing ❑ Other(specify) ❑ Landscaping <br /> Framing <br /> Insulation <br /> � As-Built Survey <br /> Final <br /> Lathe Required State Permits <br /> 0 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 />