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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> ❑ Yes '`{� No Permit Number: 13 Yes El No /A 13 Yes <br /> No <br /> J 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 /> EXE � Yes 13 No ❑ Yes No <br /> 1 2 3 4 5 �. 1� �—' y e( ): Type(s): <br /> titrA( wo <br /> Fees to be Charged 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 Footage <br /> Basement X = $ <br /> 1 sc Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> CIO <br /> Estimated Construction Value: <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing ding/Filling <br /> ❑ Poured Wall " �//�V,45;r l <br /> 13 Foundation S / / " 1 y! ter Connection <br /> ❑ Framing ver Connection <br /> ❑ Waterproof L� �� cue-�ain Irrigation <br /> � co dsca in <br /> ❑ Foundation W (�� —7 / p g <br /> Framing <br /> Insulation <br /> ❑ As-Built Sury // (� L,� L u 1917Z l <br /> Final <br /> ❑ LatheQ U6N�Q5 4 3ermits <br /> 13 Other(specify <br /> Y/ ctrical <br /> REMARKS (in-hc <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> See Builder Ac�knle�dgem�enFrmPrior t ease as-built surve arc <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />