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, � <br /> PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS <br /> " � �i/�� c�C��Z.�' <br /> Address: 1.:.. /B ,��,s►�"„��� �, � G��� Permit No.: <br /> Description of work: Date Rec'd: <br /> Septic review by: Date Approved: <br /> Zoning review by: Date Approved: <br /> ✓ <br /> Building review by: " Date Approved: <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? � Yes Landscaper: � 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 /> Buildinq Heiaht Analysis: <br /> Distance Between First Floor and defined Top of � � � <br /> Roo�` See "buildin hei ht" definition : a <br /> First Floor Elevation from buildin lans : (b) <br /> Highest Existing ground level (per survey) or 10' ��� <br /> above lowest round level, whichever is lower: <br /> Difference between b and c : (d) <br /> DEFINED HEIGHT If highest existing grade is: �e` <br /> above FFE-Height is(a)-(d) � <br /> below FFE-Height is(a)+(d) <br /> Shoreland District MCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> Permit Number: 0 Yes � No � N/A � Yes � <br /> 0 Yes 0 No 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 s % and s <br /> � Yes � No 0 Yes � No <br /> 1 2 3 4 5 Type(s): Type(s): <br /> Updated: October 2016 <br /> v:\forms�plan review checklist 10-2016.docx <br />