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Earth Movement-Cubic Yards <br /> In Out Total <br /> Haul Route? ? ® Yes 0 No <br /> Explain haul route in detail: <br /> Fees to be Charged Am nt Orono Inspections Required <br /> Permit Fee p 14 'PC ® Site <br /> O Hardcover Removal <br /> Escrow Amount U Footing <br /> ® Poured Wall <br /> Escrow Agreement received? p As-Built Survey <br /> ® Yes ® No ® Planting Plan <br /> O Wetland Buffer <br /> Escrow Money received? Einal <br /> O Yes ® No 0 Other(specify) <br /> Engineering review needed? <br /> ® Yes C No <br /> REMARKS (in-house): <br /> Other Review: Reviewed by: Date Approved: <br /> REMARKS(TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT) <br /> Updated:January 2013 <br /> z:\forms\plan review checklist for zoning permit applications 2013.docc <br />