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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> )< <br /> Yes ❑ No Permit Number: Ko _355 ❑ Yes 0 No V N/A 0 Ye No <br /> 0 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 /> W/0 0 Yes k-No 0 Yes )(No <br /> Oi <br /> 2 3 4 5 i�Ul�.9 Type(s): Type(s): <br /> I(40Fees to be Charged YES NO <br /> Permit iif <br /> Plan Review V <br /> State Surcharge 1/" <br /> Investigation Fee V <br /> SAC-Number of SAC Units V' <br /> Other(specify) t./ <br /> Square Footage $ per Square Footage <br /> Basement X = $ <br /> 1st Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X �f <br /> t' = $ <br /> Estimated Construction Value: $ , 700).000 <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site Plumbing 0 Grading/Filling <br /> Poured Wall )(Silt Fence/Erosion Control Mechanical 0 Fire <br /> Foundation Survey 0 Hardcover Removal Fireplace 0 Water Connection <br /> 0 Framing 0 Other(specify) 0 Masonry 0 Sewer Connection <br /> Waterproofing/Drain tile Mfg. 0 Lawn Irrigation <br /> Foundation Waterproofing 0 Other(specify) 0 Landscaping <br /> 'FC Framing <br /> pr Insulation <br /> X As-Built Survey <br /> lie Final <br /> ❑ Lathe d 1 Required State Permits <br /> '` .other(specify) Pie k/39194,e, eS"'",1. � — <br /> 7�� 11 Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> Ny: See Builder Acknowledgement Form <br /> ❑ Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Co tEIU ANrs I/414- 1Q-e u u26 20 Pl-4P /►4bu 7" 772-e-6-5 PEa 5-ricgto <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />