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Average Lakeshore Setback <br /> Shoreland District MCWD Permit Eget? Bluff <br /> Permit Number: R CF Yes No N/A 0 Yes <br /> 0 Yes7No No <br /> O 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 /> Cl Yes ✓,•(No Cl Yes 9(No <br /> 1 2 3 4 5 .rte" -ft Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit <br /> Plan Review <br /> State Surcharge V <br /> investigation Fee <br /> SAC-Number of SAC Units <br /> Other(specify) <br /> • <br /> Square Footage $per Square Footage <br /> Basement X = $ <br /> 1$'Floor X = $ <br /> 2^d Floor X = $ <br /> Garage X = $ - <br /> � 5-*".4.-+ <br /> t — <br /> Estimated Construction Value: $ 1 (uV <br /> Orono Inspections Required Work Requiring Separate Permits <br /> M=ooting CI Site Cl Plumbing CI Grading/Filling <br /> Poured Wall CI Silt Fence/Erosion Control 2f<Mechanical 0 .Fire. <br /> O Foundation Survey D Hardcover Removal CI Fireplace 0 Water Connection <br /> O Framing Cl Other(specify) a Masonry 0 Sewer Connection <br /> D Waterproofing/Drain tile CI Mfg. CI Lawn Irrigation <br /> CI Foundation Waterproofing CI Other(specify) Cl`Landscaping <br /> D Framing <br /> 0 _insulation <br /> 4 As-Built Survey <br /> Final <br /> a Lathe Required State Permits <br /> O Other(specify) )(Electrical <br /> D Well <br /> REMARKS(in-house): <br /> OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> See Builder Acknowledgement Form <br /> CI 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 />