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1 t <br /> Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> ❑ Yes No Permit Number: 1 -533(0 ❑ Yes ❑ No % N/A D YeAAI, No <br /> ❑ N/A-see attached w Setback: <br /> Stormwater Quality Existing Proposed <br /> Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> (circle one) (%and sf) (% and sf) <br /> ❑ Yes `I No ❑ Yes Flo <br /> 1 2 3 4 '0 )(eotyy4--- -------* Type(s): \• Type(s): <br /> Fees to be Charged YES NO <br /> Permit Vf <br /> Plan Review t/' <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 /> 1st Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ Zec(9`(900 PO <br /> J <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing ❑ Site zX Plumbing 0 Grading/Filling <br /> Poured Wall 7Vr.,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 /> Framing <br /> Insulation <br /> tiK As-Built Survey <br /> 21. Final <br /> �( Lathe Required State Permits <br /> /❑ Other(specify) <br /> 21(Well fX.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 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 />