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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> �Yes � No Permit Number: 0 Yes 0 No ��N/A � Ye 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 /> �y-,q���V L.-�,��`��rl�- 0 Yes � �No 0 Yes No <br /> 1 2 3 4 5 ,� �.�, � Type(s): Type(s): <br /> : ��1� � �=�7 ��, =� �a���. <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 /> 2"d FI00� X = $ <br /> Garage X = $ <br /> ./' <br /> Estimated Construction Value: $ i ��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing 0 Site � Plumbing � Grading/ Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control ❑ Mechanical 0 Fire <br /> � Foundation Survey 0 Hardcover Removal � Fireplace � Water Connection <br /> � Framing ther(specify) � Masonry � Sewer Connection <br /> � Waterproofing/Drain tile ''� l � Mfg. 0 Lawn Irrigation <br /> ❑ Foundation Waterproofing / ''��u e- /�G�s p Other(specify) 0 Landscaping <br /> Framing �� <br /> Insulation <br /> 0 As-Built Survey <br /> Final <br /> � Lathe Required State Permits <br /> � Other(specify) <br /> 0 Well 0 Electrical <br /> a <br /> REMARKS (in�ouse): u��i� �.1�-� ���� /��% i 1, <br /> ��,�"�u�� l � C�1 C(�� �'4I �� j L.(� �.�� ,� ;��, ���,� � y�,;, <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> �ee 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 />