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. . � <br /> Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Permit Number: � Yes 0 No � N/A 0 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 /> ❑ Yes 0 No � Yes � No <br /> 1 2 3 4 � 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit i/' <br /> Plan Review � <br /> State Surcharge �- <br /> Investigation Fee � <br /> SAC— Number of SAC Units �/ <br /> Other(specify) �_ <br /> Square Foota e $ er Square Foota e <br /> Basement X = $ <br /> 1 S� Floor X = $ <br /> 2nd FIoOP X = $ <br /> Garage X = $ <br /> ,t� G� <br /> Estimated Construction Value: $ � � � 0�V <br /> .. y <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing O Site Plumbing 0 Grading/Filling <br /> 0 Poured Wall 0 Silt Fence/Erosion Control �Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal ❑ Fireplace 0 Water Connection <br /> 0 Framing ❑ Other(specify) ❑ Masonry ❑ Sewer Connection <br /> � Waterproofing/Drain tile 0 Mfg. � Lawn Irrigation <br /> ❑ Foundation Waterproofing ❑ Other(specify) ❑ Landscaping <br /> � Framing <br /> Insulation <br /> 0 As-Built Survey <br /> Final <br /> � Lathe Required State Permits <br /> 0 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 and hardcover calculations must be submitted and approved. <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />