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Shorieland District MCWD Permit Average Lakeshore Setback g�uff <br /> M et? <br /> Permit Number: I _ �7 /� 0 Yes 0 No �q � Yes <br /> Yes � No v 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 /> 1 2 3 4 5 � 1`��� w•�d � Yes o ❑ Yes o <br /> � O�' Type(s): Type(s): <br /> � 7Co3S 14 S� <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 Vr <br /> Other(specify) <br /> Square Footage $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd FlOor X = $ <br /> Garage X = $ <br /> � l <br /> Estimated Construction Value: $ 2 /,�(�d <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing ❑ Site � Plumbing � Grading/Filling <br /> ❑ Poured Wall Silt Fence/Erosion Control 0 Mechanical � Fire <br /> ❑ Foundation Survey ❑ Hardcover Removal O Fireplace � Water Connection <br /> � Framing ❑ Other(specify) 0 Masonry � Sewer Connection <br /> � Waterproofing/Drain tile ❑ Mfg. 0 Lawn Irrigation <br /> � Foundation Waterproofing � Other(specify) 0 Landscaping <br /> Framing <br /> � Insulation <br /> � As-Built Survey <br /> Final <br /> 0 Lathe Required State Permits <br /> ❑ Other(specify) <br /> 0 Well Electrical <br /> REMARKS (in-house): N U� rC,(�Qi(� �U•�7� �� <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> � See Builder Acknowledgernent 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 />