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o�^` <br /> V��, <br /> verage Lakeshore Setback <br /> Shoreland District MCWD Permit � ` Met? Bluff - <br /> Yes � No Permit Number: I� , � Yes � No �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 /> circie one % and sf % and sf <br /> �,� � �ji� � Yes No 0 Yes o <br /> 1 2 3 4 5 Type(s): Type(s): <br /> zgz5 sf� <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plan Review <br /> State Surcharge U— <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 Floo� X = $ <br /> Garage X = $ <br /> � <br /> Estimated Construction Value: $ � ' e ��(� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> ooting 0 Site �Plumbing � Grading/Filling <br /> Poured Wall l�,Silt Fence/Erosion Control `S[ Mechanical � Fire <br /> �C.,Foundation Survey � Hardcover Removal �� Fireplace 0 Water Connection <br /> � Framing 0 Other(specify) � Masonry �Sewer Connection <br /> Waterproofing/Drain tile �Mfg. � Lawn Irrigation <br /> Foundation Waterproofing � Other(specify) � Landscaping <br /> Framing <br /> Insulation <br /> 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 /> �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 />