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Average Lakeshore Setback � g�uff� <br /> Shoreland District MCWD Permit Met? <br /> Yes � No Permit Number: ' � Yes 0 No �N/A � Ye Na <br /> � N/A—see attached s 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'�p�;�� �J,���� � Yes No � Yes No <br /> 1 2 � 4 5 - <br /> ,- '� l,- � � . — ' -,,� c�f . Type(s): Type(s): <br /> J � <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 S� Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $, _�, ��� <br /> Orono Inspections Required , Work Requiring Separate Permits <br /> �Footing 0 Site 0 Plumbing 0 Grading/Filling <br /> � Poured Wall ❑ Silt Fence/Erosion Control 0 Mechanical ❑ Fire <br /> � Foundation Survey � Hardcover Removal ❑ Fireplace 0 Water Connection <br /> 0 Framing � Other(specify) � Masonry 0 Sewer Connection <br /> � Waterproofing/Drain tile � Mfg. 0 Lawn Irrigation <br /> � Foundation Waterproofing � Other(specify) ❑ Landscaping <br /> Framing <br /> 0 Insulation <br /> 0 As-Built Survey <br /> Final <br /> Lathe Required State Permits <br /> 0 Other(specify) <br /> 0 Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> ui e orm �a d� �1�W SOt I� rnc��- �- e�, �t��h�- <br /> � Prior to release of escrow money an-.a�la � c.av�aJculati <br /> I( '� � c . <br /> IA i i , <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />