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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes 0 No Permit Number: � Yes � 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 /> O Yes 0 No � Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Perm it <br /> Plan Review <br /> State Surcharge L� <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 S� Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> -� <br /> Estimated Construction Value: $ `-�� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site 0 Plumbing � Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control � Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal 0 Fireplace � Water Connection <br /> 0 Framing � Other(specify) � Masonry 0 Sewer Connection <br /> � Waterproofing/Drain tile 0 Mfg. � Lawn Irrigation <br /> � Foundation Waterproofing � Other(specify) 0 Landscaping <br /> Framing <br /> 0 Insulation <br /> � As-Built Survey <br /> Final <br /> 0 Lathe Required State Permits <br /> � Other(specify) <br /> 0 Well 0 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 />