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PLAN 11%0 TOM <br /> FOR NEW STRUCTURES / ADDITIONS <br /> Address: 1` oy TOM U yle- I�L� Permit No.: .2a-7 004 <br /> Description of work: DKK Date Rec'd: ' <br /> Septic review by: Date Approved: <br /> Zoning review by: Date Approved: �• 131-1 <br /> Building review by: Date Approved: <br /> Grading review by: NA _ Date Approved: <br /> Zoning District: Zoning File M <br /> Resolution? Yes Reso M Reso Date: Signed: Yes No Resolutio(.r> <br /> Zoning: Lot Area: 6.qj_SF/AC) Width: Structural Coverage: SF % <br /> Survey Submitted: /P'Ies ❑ No Date of Survey: ' �3 "�� Revised date(: <br /> Landscape plan submitted? ❑ Yes Landscaper: ❑ No/None proposed <br /> Proposed Setbacks: <br /> Front Rear(St et) S E W ) ( N (P E W ) Other Buildings Wetland <br /> Side ide <br /> Crzpo ' 75' Z57 ' o <br /> Building Height Analysis: <br /> Distance Between First Floor and defined Top of (a) <br /> Roof* See "building height" definition <br /> First Floor Elevation (from buildingplans): (b) <br /> Highest Existing ground levef(per survey) or 10' (c) <br /> above lowest ground level, whichever is lower: <br /> Difference between b and (c): (d) <br /> Defined Buildin Height (a) - (d): (e) <br /> Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> /No Met? <br /> Permit Number: PA_ 13 Yes ❑ No N/A ❑ Ye <br /> 13 Yes � 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 s <br /> ❑ Yes MNo Cl Yes Af No <br /> 1 2 3 4 5 G —' Type(s): Type(s): <br /> Updated: October 2016 <br /> v:\forms\plan review checklist 10-2016.docx <br />