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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> M et? <br /> Permit Number: � � Yes 0 No N/A � Yes <br /> Yes � 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 f <br /> 0 Yes No 0 Yes o <br /> 1 2 � 4 5 �l � Type(s): Type(s): <br /> � <br /> I�C t--� i Yli.1.uL�..�� � ,�l r�v�e�t���,� . <br /> Fees to be Char ed ' YES NO <br /> Permit � <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 /> 15t Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site �Plumbing � Grading/Filling <br /> Poured Wall ilt Fence/Erosion Control Mechanical � Fire <br /> � Foundation Survey � Hardcover Removal � Fireplace � Water Connection <br /> � Framing � Other(specify) � Masonry � Sewer Connection <br /> � Waterproofing/Drain tile 0 Mfg. 0 Lawn Irrigation <br /> ❑ Foundation Waterproofing 0 Other(specify) � Landscaping <br /> Framing <br /> 0 Insulation <br /> 0 As-Built Survey <br /> ' al <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 mone aa-as=b�-si�#e�� '���. �- ���t5r�!( �� <br /> y �b y-��l ►ons-must-be subrxaittgd-and appr ved. <br /> U�'�CN` �+- a_ �1�.- <<i�.S��7(%►�- �l�� °� <br /> Updated: May 2016 <br /> z:\formslplan review checklist 5-2016.docx <br />