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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? • <br /> � Yes 0 No Permit Number: � Yes 0 No 0 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 /> � Yes 0 No 0 Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(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 �� �' <br /> Other(specify) <br /> Square Footage $ per Square Foota e <br /> Basement X = $ <br /> 1St Floor X = $ <br /> 2nd FloOr X = $ <br /> Garage X = $ <br /> c�,p <br /> Estimated Construction Value: $ ���i�/ - <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing 0 Site Plumbing � Grading/Filling <br /> ❑ Poured Wall ❑ Silt Fence/Erosion Control Mechanical 0 Fire <br /> ❑ Foundation Survey � Hardcover Removal � Fireplace � Water Connection <br /> 0 Framing � Other(specify) 0 Masonry 0 Sewer Connection <br /> ❑ Waterproofing/Drain tile � Mfg. � Lawn Irrigation <br /> ❑ Foundation Waterproofing � Other(specify) ❑ Landscaping <br /> Framing <br /> nsulation <br /> � As-Built Survey <br /> �Final <br /> 0 Lathe Required State Permits <br /> � Other(specify) <br /> � Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> � See Builder Acknowledgement Form <br /> 0 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 />