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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> ❑ Yes <br /> Yes D No Permit Number: IV — 10(00 Yes ❑ No D N/A No <br /> ❑ N/A see attached Setback: <br /> Stormwater Quality Existirhg. - ' Proposed <br /> Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> (circle one) (% and sf) (% and sf) /No❑ YesNoD Yes <br /> 3 4t 5 Type(s)•` Type(s): <br /> Fees to be Charged YES NO <br /> Permit <br /> Plan Review v' <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: $ <br /> 2.5",e0 � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing D Site D Plumbing D Grading/Filling <br /> D Poured Wall D Silt Fence/Erosion Control Mechanical D Fire <br /> D Foundation Survey 0 Hardcover Removal 0 Fireplace 0 Water Connection <br /> D Framing 0 Other(specify) 0 Masonry 0 Sewer Connection <br /> D Waterproofing/Drain tile 0 Mfg. 0 Lawn Irrigation <br /> O Foundation Waterproofing 0 Other(specify) 0 Landscaping <br /> O Framing <br /> O Insulation <br /> s-Built Survey <br /> Final <br /> O Lathe Required State Permits <br /> D Other(specify) <br /> 0 Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> y<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 />