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Earth Movement - Cubic Yards <br /> In Out Total <br /> 314' <br /> Haul Route? ? D Yes 0 No <br /> Explain haul route in detail: pitO ' CV Lol 1 nl T 20*-0077/ <br /> ( 5røu4 poo.) <br /> Fees to be Charged Amount Orono Inspections Required <br /> Permit Fee Amount <br /> 0 Site <br /> Escrow Amount 0 Hardcover Removal <br /> ' 2Df(Q,-00701 0 Footing <br /> Escrow Agreement received? ` 0 Poured Wall <br /> As-Built Survey <br /> O Yes 0 No 0 Planting Plan <br /> 0 Wetland Buffer <br /> Escrow Money received? At<kinal <br /> O Yes 0 No 0 Other (specify) <br /> Engineering review needed? <br /> Yes 0 No <br /> REMARKS (in-house): <br /> Other Review: Reviewed by: Date Approved: <br /> REMARKS (TO BE NOTED ON PERMITTAND ,INITIALLED BY PERSON nPULLING <br /> �PPyERMIT <br /> Fiat (( Y • esu- v4 Veli 0,J-4ll Ufra <br /> nks J <br /> �- � � . <br /> Updated:January 2013 <br /> z:\forms\plan review checklist for zoning permit applications 2013.docx <br />