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PLAN REVIEW CHECKLIST FOR STRUCTURES / ADDITIONS <br /> Add:ess: �O C/ (/(/ Permit No.: CO,6 � <br /> Description of work: Date Rec'd: <br /> Septic review by: Date Approved: <br /> Zoning review by: Date Approved: <br /> Building review by: Date Approved: ✓ l / <br /> Grading review by: Date Approved: <br /> Zoning District: Zoning File#: <br /> Resolution? Yes Reso M Reso Date: Signed: Yes No Resolution/ NA <br /> Zoning: Lot Area: SF /AC Width: Strut ural Coverage: SF <br /> Survey Submitted: 0 Yes 0 No Date of Survey: Revised date(?): <br /> Landscape plan submitted? 0 Yes Landscaper: 0 No/ None proposed <br /> i <br /> Proposed Setbacks: <br /> Front(Lake) Rear(Street) ( N S E W ) ( S E W ) Other Buildings Wetland <br /> Side Side <br /> Buildina Hei ht Analysis: <br /> Distance Between First Floor and defined op of Roof* (See "building height" (a) <br /> definition): <br /> First Floor Elevation from building plans)- (b) <br /> Highest Existing ground level (per survey) or 1 ' above lowest ground level, (c) <br /> whichever is lower: <br /> Difference between b and (c)*: (d) <br /> DEFINED HEIGHT <br /> "If highest existing adjacent grade is above F E-Height (a)-(d): (e) <br /> *If highest existing adjacent grade is below FE-Hei ht i a +(d) E:]� <br /> Shoreland District MCW Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes 0 No Permit Number: 0 Yes 0 No 0 N/A 0 Yes D o <br /> 0 N/A—see a ached Setback: <br /> Stormwater Quality E#isting Propo ed <br /> Overlay District Tier H rdcover Hardco4r Variance Required CUP Required, <br /> circle one /o and sf % and s <br /> 0 Yes 0 No 0 Yes 0 o <br /> 1 2 3 4 5 ` Type(s): Type(s): <br /> Updated: June 2017 <br /> z:\forms\plan review checklist 06-2017.docx <br />