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' �PLA�I REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS <br /> Address: Q�� W`� Permit No.: L�! ( — d��� <br /> Description of work: '�'Y�Q ( � S Date Rec'd: 1 � '�� ��� <br /> Septic review by: -- '""" Date Approved: - <br /> Zoning review by: Date Approved: ���l•���� r <br /> Building review by: Date Approved: �7 ' <br /> Grading review by: �� Date Approved: '� � <br /> Zoning District: Zoning File#: <br /> Resolution? Yes Reso#: Reso Date: Signed: Yes No Resolution /NA <br /> Zoning: Lot Area: SF/AC Width: Structural Coverage: SF % <br /> Survey Submitted: � Yes 0 No Date of Survey: Revised date(?): <br /> Landscape plan submitted? 0 Yes Landscaper: 0 No/ None proposed <br /> Pro osed Setbacks: <br /> Front(Lake) Rear(Street) ( N S E W ) ( N S E W ) Other Buildings Wetland <br /> Side Side <br /> Buildin Hei ht Anal sis: <br /> Distance Between First Floor and defined Top of Roof"` (See"building heighY' �a� � <br /> definition : <br /> First Floor Elevation from buildin lans : (b) <br /> Highest Existing ground level (per survey) or 10' above lowest ground level, ��� <br /> whichever is lower: <br /> Difference between b and c *: (d) <br /> DEFINED HEIGHT <br /> "If highest existing adjacent grade is above FFE-Height is(a)-(d): (e) <br /> "If hi hest existin ad'acent rade is be/ow FFE-Hei ht is a + d <br /> Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> � Yes � No Permit Number: � Yes 0 No 0 N/A � Yes � 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 s % and s <br /> 0 Yes � No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Updated: June 2017 <br /> z:\forms\plan review checklist 06-2017.docx <br />