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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> ' Met? � <br /> Permit Number: 0 Yes � No 0 N/A � Yes �,� <br /> es O 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 /> ��,,���� (r-" , � Yes 0 No � Yes No <br /> � 2 3 4 5 , - - - YPe�S)� TYPe�s)� <br /> - ��!"2 � ����� � -� . <br /> Fees to be Char ed YES NO <br /> Perm it <br /> Plan Review <br /> State Surcharge <br /> Investigation Fee <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Foota e $ per Square Foota e <br /> Basement X - $ <br /> 1 St Floor X = $ <br /> 2nd FloOr X = $ <br /> Garage X = g <br /> Estimated Construction Value: $ f 3. ��D <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site � Plumbing � Grading/Filling <br /> � Poured Wall 0 Silt Fence/Erosion Control � Mechanical � Fire <br /> 0 Foundation Survey 0 Hardcover Removal � Fireplace O Water Connection <br /> � Framing 0 Other(specify) 0 Masonry 0 Sewer Connection <br /> 0 Waterproofing/Drain tile � Mfg. � Lawn Irrigation <br /> 0 Foundation Waterproofing 0 Other(specify) � Landscaping <br /> Framing <br /> ❑ Insulation <br /> s-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 /> i der Ac gement Form <br /> �rior to release of escrow money � . <br /> l 1 0' �T p� <br /> �n�.c firM c�rrtnl��, <br /> Updated: ay 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />