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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> M et? <br /> Permit Number: � - 0 Yes ❑ No N/A � Yes <br /> �Yes � No ��—��� 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 /> 0 Yes No 0 Yes o <br /> 1 2 � . 3Q 4 5 � �`►(� TYPe�S):., TYPe�s)� <br /> Fees to be Char ed YES NO <br /> Permit t/ <br /> Plan Review r/ <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 FI00� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ ,7� �� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site � Plumbing ❑ Grading/Filling <br /> ❑ Poured Wall O Silt Fence/Erosion Control � Mechanical O Fire <br /> ❑ Foundation Survey e Hardcover Removal � Fireplace O Water Connection <br /> � Framing Other(specify) 0 Masonry ❑ Sewer Connection <br /> 0 Waterproofing/Drain tile 0 Mfg. ❑ Lawn Irrigation <br /> ❑ Foundation Waterproofing ���" ����1 � Other(specify) � Landscaping <br /> � Framing <br /> ❑ Insulation <br /> �ps-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 /> �Prior to release of escrow money an as-built survey must be submitted and approved. <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />