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Average Lakeshore Setback g�uff <br /> Shoreland District MCWD Permit Met? <br /> Permit Number: 0 Yes No � N/A � Yes <br /> �Yes 0 No No <br /> /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 /> ��1� 2 3 �4 5 2' ��ld,- � �_;�'T�-.� Yes 0 No 0 Yes No <br /> -� .�� -�-'� _.� ,.�`T'� � , ��I Y������ �ype�s�� <br /> _ �- � <br /> f , <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 FIoO� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ (U�, ` (� � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site Plumbing ❑ Grading/Filling <br /> Poured Wall 1�,Silt Fence/Erosion Control Mechanical 0 Fire <br /> � Foundation Survey 0 Hardcover Removal � Fireplace ❑ Water Connection <br /> 0 Framing 0 Other(specify) 0 Masonry ❑ Sewer Connection <br /> Waterproofing/Drain tile 0 Mfg. 0 Lawn Irrigation <br /> Foundation Waterproofing � Other(specify) 0 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): c�N S �' <br /> O��i'bv'c..d u�l �2.e.�d u �o� co� t7•tc. i c�a,r �� �. t���I�o s.�c.�nt c�,,� ar�,v��l. <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 />