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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> �Yes 0 No Permit Number: Yes 0 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 /> 2�,�� 4']'V 0 Yes No 0 Yes No <br /> 1O 2 3 4 5 �b��(�7 Sr, ►`� I v 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 � <br /> Other(specify) (� <br /> Square Footage $ per Square Foota e <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> 2nd Floo►' X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ � ��, Q��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> � Footing � Site Plumbing � Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control Mechanical � Fire <br /> 0 Foundation Survey ❑ Hardcover Removal � Fireplace � Water Connection <br /> � Framing 0 Other(specify) � Masonry ❑ Sewer Connection <br /> � Waterproofing/Drain tile � Mfg. ❑ Lawn Irrigation <br /> 0 Foundation Waterproofing 0 Other(specify) � Landscaping <br /> Framing <br /> Insulation <br /> � As-Built Survey <br /> �Final <br /> �( Lathe Required State Permits <br /> 0 Other(specify) <br /> 0 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 � � � pr ed. <br /> oE,t� C�,ls ' ,rb�e _ rc� ���tblrll� cuI V� �a�i�• <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />