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Shoreland Distric� MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> Permit Number: � Yes ❑ No � N/A 0 Yes � <br /> 0 Yes 0 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 /> � Yes � No � Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <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 t/' <br /> Other(specify) {/`- <br /> Square Footage $ per Square Foota e <br /> Basement X - g <br /> 1 St Floor X = $ <br /> 2nd FIoOr X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �/�/,��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site � Plumbing � Grading/Filling <br /> 0 Poured Wall � Silt Fence/Erosion Control � Mechanical 0 Fire <br /> 0 Foundation Survey 0 Hardcover Removal 0 Fireplace ❑ Water Connection <br /> � Framing �Other(specify) O Masonry � Sewer Connection <br /> � Waterproofing/Drain tile I//� � 0 Mfg. � Lawn Irrigation <br /> � Foundation Waterproofing w `�' �y � Other(specify) 0 Landscaping <br /> Framing ���/„�. <br /> Insulation <br /> � As-Built Survey <br /> Final <br /> 0 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 /> 0 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:lforms\plan review checklist 5-2016.docx <br />