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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> M et? <br /> Permit Number: �-t'�� ❑ Yes � No �N/A � Yes <br /> �Yes 0 No � �v No <br /> 0 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 /> �L���� 0 Yes No 0 Yes No <br /> 1 2 3 4 5 --� 11�75`�'S� Type�s�.' Type(s): <br /> Fees to be Char ed YES NO <br /> Permit v' <br /> Plan Review v+ <br /> State Surcharge V. <br /> Investigation Fee �/ <br /> SAC-Number of SAC Units (/� <br /> Other(specify) v� <br /> Square Footage $ per Square Foota e <br /> Basement 3.S�f-7 X , Z = $ � Z <br /> 1 St Floor .�T 7 X `��, _ $ �-- �Z •Z <br /> ��� �U''T - X �. ?� _ $ ZZ ���� <br /> Garage l 57 y'�z; 3��-8 X � � � - $ Z Jr � <br /> Estimated Construction Value: ��g,��� �g�� <br /> I <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site � Plumbing ❑ Grading/Filling <br /> Poured Wall Silt Fence/Erosion Control Mechanical ❑ Fire <br /> Foundation Survey � Hardcover Removal '6�Fireplace � Water Connection <br /> � Framing ther(specify) 6 0 Masonry � Sewer Connection <br /> �(,Waterproofing/Drain tile n�lG� -y--► �.Mfg. � Lawn Irrigation <br /> Foundation Waterproofing �J �� � Other(specify) 0 Landscaping <br /> `,�. Framing <br /> �( Insulation 3"`���eC <br /> As-Built Survey <br /> �( Final <br /> ❑ 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 /> ❑ 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 />