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Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> Permit Number: �(n —4�� � Yes � No �A � Ye No <br /> Yes ❑ No �r <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 /> � �L��q�,l� � Yes o 0 Yes No <br /> 1 2 /' 3 ) 4 5 ./� a Type(s): Type(s): <br /> �� � 3,��4s i- <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 /> '``'C' �'C�C� <br /> Estimated Construction Value: $ / �, <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing 0 Site � Plumbing +. � Grading/Filling <br /> Poured Wall Silt Fence/Erosion Control Mechanical � Fire <br /> �,Foundation Survey � Hardcover Removal �Fireplace 0 Water Connection <br /> 0 Framing 0 Other(specify) � Masonry 0 Sewer Connection <br /> �Waterproofing/Drain tile �Mfg. 0 Lawn Irrigation <br /> � Foundation Waterproofing � Other(specify) 0 Landscaping <br /> Framing <br /> Insulation <br /> �As-Built Survey <br /> �Final <br /> �Z4 Lathe Required State Permits <br /> 0 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 /> � rior 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 />