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Average Lakeshore Setback <br /> Shoreland District fi.4CWD PermitMet? Bluff <br /> Permit Number: 0Yes 0 No 0 N/A 0 Yes 0 <br /> 0 Yes rl No 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 /> 0 Yes Ci No 0 Yes 0 No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit <br /> Plan Review <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 /> 161 Floor X = $ <br /> 2nd Floor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ <br /> Orono inspections Required Work Requiring Separate Permits <br /> O Footing 0 Site 0 Plumbing 0 Grading/Filling <br /> O Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical 0 Fire <br /> O Foundation Survey 0 Hardcover Removal 0 Fireplace 0 Water Connection <br /> O Framing Ci Other(specify) 0 Masonry 0 Sewer Connection <br /> O Waterproofing/Drain tile 0 Mfg. CI Lawn Irrigation <br /> O Foundation Waterproofing 0 Other(specify) 0 Landscaping <br /> O Framing <br /> O Insulation <br /> O As-Built Survey <br /> O Final <br /> O Lathe Required State Permits <br /> © Other(specify) <br /> 0 Well 0 Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REI ARicS-TO BE NOTED ON PERMIT AND INITIALLED: <br /> O See Builder Acknowledgement Form <br /> O Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: May 2016 <br /> z:lforms\plan review checklist 5-2016.docx <br />