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Shoreland District MCWD Permit Average Lakeshore Setback Bluff . <br /> Met? <br /> es � No Permit Number: s O No � N/A � Ye Na <br /> /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�jj� �_�'; � � Yes .9'No 0 Yes No <br /> U 2 3 4 5 Type(s): Type(s): <br /> ( I ; ��;p� 11 , ;; _ <br /> Fees to be Char ed YES NO <br /> Permit �;~ <br /> Plan Review ' �— <br /> �� <br /> State Surcharge �/'� <br /> Investigation Fee �_,-'�` <br /> SAC—Number of SAC Units l/� <br /> Other(specify) � <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 S� Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: CX�� � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing 0 Site � Plumbing 0 Grading/Filling <br /> � Poured Wall Silt Fence/Erosion Control � Mechanical � Fire <br /> � Foundation Survey 0 Hardcover Removal Fireplace � Water Connection <br /> � Framing � Other(specify) � Masonry � Sewer Connection <br /> � Waterproofing/Drain tile �Mfg. � Lawn Irrigation <br /> 0 Foundation Waterproofing � Other(specify) � Landscaping <br /> �Framing <br /> � Insulation <br /> � As-Built Survey <br /> �Final <br /> 0 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 /> �Prior to release of escrow money a �� ��� � � and approved. <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />