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Shoreland District MCWD Permit Average Lakeshore Setback gluff <br /> M et? <br /> 0 Yes o Permit Number: � Yes � No �A � Ye No <br /> 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 /> � Yes o � Yes No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Fees to be Char ed YES NO <br /> Permit �/' <br /> Plan Review 1./' <br /> State Surcharge <br /> Investigation Fee - �, <br /> SAC—Number of SAC Units U <br /> Other(specify) <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 St Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> .� ,�j � <br /> Estimated Construction Value: � �—(%, ��� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing � Site 0 Plumbing � Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control � Mechanical 0 Fire <br /> � Foundation Survey � Hardcover Removal 0 Fireplace 0 Water Connection <br /> � Framing � Other(specify) � Masonry � Sewer Connection <br /> � Waterproofing/Drain tile 0 Mfg. � Lawn Irrigation <br /> 0 Foundation Waterproofing 0 Other(specify) � Landscaping <br /> �Framing <br /> 0 nsulation <br /> As-Built Survey <br /> Final <br /> 0 Lathe Required State Permits <br /> � Other(specify) <br /> 0 Well Iectrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> 0 See Builder Acknowledgement Form <br /> `�Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> . � <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />