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f,���� ��I /��'J y�'�y ,; , . <br /> ,t <br /> Average Lakeshore Setback g�uff <br /> Shoreland District MCWD Pe it Met? <br /> �Yes 0 No <br /> Permit Number: t � � ❑ Yes 0 No N/A � Ye 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 /> j . ) � � Yes ❑ No � Yes No <br /> 1 2 � 4 5 � � <br /> ,, ,' Type(s): Type(s): <br /> l J i ,;';,J ( , <br /> , <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 Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2"d FIoOr X = $ <br /> Garage X = $ <br /> /�,� �' h <br /> Estimated Construction Value: $ `/, ('�U <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing � Site � Plumbing ❑ Grading/Fil►ing <br /> � Poured Wall � Silt Fence/Erosion Control O Mechanical � Fire <br /> 0 Foundation Survey ❑ Hardcover Removal 0 Fireplace � Water Connection <br /> 0 Framing 0 Other(specify) 0 Masonry 0 Sewer Connection <br /> ❑ Waterproofing/Drain tile ^^r� ���� � Mfg. � Lawn Irrigation <br /> P g � � / �" � Other(specify) ❑ Landscaping <br /> 0 Foundation Water roofin <br /> ❑ Framing JC��L( o� �-�vl� e Qs <br /> 0 Insulation <br /> As-Built Survey �d�f�e�f <br /> Final <br /> 0 Lathe Required State Permits <br /> ❑ Other(specify) <br /> � Wetl ❑ 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 />