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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> Yes p �o Permit Number: � Yes 0 No N/A � Ye No <br /> 0 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 °/a and sf <br /> �� ���"��� ��,�3�l� 0 Yes No � Yes No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> �3q�3��. �3�3��. <br /> Fees to be Char ed YES NO <br /> Permit �� <br /> Plan Review (�-� <br /> State Surcharge (� <br /> Investigation Fee <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 S� Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ <br /> D ° <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing 0 Site � Plumbing � Grading/Filling <br /> � Poured Wall � Silt Fence/Erosion Control � Mechanical � Fire <br /> � Foundation Survey 0 Hardcover Removal � Fireplace � Water Connection <br /> 0 Framing � Other(specify) � Masonry � Sewer Connection <br /> � Waterproofing/Drain tile 0 Mfg. 0 Lawn Irrigation <br /> � Foundation Waterproofing 0 Other(specify) � Landscaping <br /> Framing <br /> � Insulation <br /> s-Built Survey <br /> Final <br /> Lathe Required State Permits <br /> 0 Other(specify) <br /> � Well Electrical <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 /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />