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�L�,l� �E�iE1IV CF�E�K���T FO� ��W �TE�EJG��F��� / ������0l�� <br /> Adciress: � �'� ��� J i � �i� Permit No.: �� ` (�� <br /> � �•� � �� <br /> Description of work: l �..��� Date 12ec'd: <br /> Septic r��riew by: °`-�v� � Date Approveci: <br /> Zonin� re�+iewr by: �� .,..., Date�►ppro�red: > 'L � .s <br /> Buildmg reviev�r by. . Date Approvecl: •�t' <br /> � Gradin review b : � � <br /> ;, <br /> 9 Y Eat�Approveci: "� �T �� <br /> Zoning �istrict: �.-��' Zor�in� File#: B2eso#: f�eso Date: <br /> �' Zoning: Lot/�lrea: ��, B � �/AC 1Alidth: Lot CQver�g�: SF % <br /> � g <br /> � Survey Submitted: �Yes � No �ate a��urvey: �(� ` `�°���Revised date(?): <br /> ��: Proposed Setbacks: <br /> ��` Front (Lake) Rear(S�e�t� f � � E � ? ( � S E � ) Qther�uilc�ings Wetlan8 <br /> Si� Side <br /> �-� (Q e � �f �° <br /> �' <br /> � Defined Heic�ht: Peak Height: FFE: FFE rnin�s 6 feet = (Existing Contour <br /> = Perimeter(linear feet) = 50% = L.F. belovN grade #of Stories <br /> � <br /> r <br /> FOR A BUILQIt�G WI'Pki A BASEMIENT OR CRAWL SPACE: �`< �q ��.. )N; <br /> ' ',.?-k:;�� _�'�1��� �.�..���l`-��� <br /> The distance between the lowe:(�� 'y � � stance between the top of <br /> START WITH floor(of the basement or crawl: ;wf.� .�.�- , , r„�' id the highest point of the <br /> " the highest point of the roof. ` � �'" '�'`'w�� ' ' <br /> � �L1W' �t�'Gs°c `�__ t�,�6�.��.,j � <br /> ? If you have a... �i iave a... .� <br /> ;ABLE OR HIPPED ROOF <br /> • GABLE OR HIPPED ROC no windows): Subtract half <br /> windo�s}: Subtract half tt +� ne distance between the <br /> beiv,�een the highest point ;ighgst point of the roof to <br /> ,.To the low point of the corr <br /> SUBTRACTION �� gable or hipped roof oe 1ow point of the <br /> orresponding gable or <br /> (BASED ON ��- . GABLE OR HIPPED ROC �ipped roof <br /> ROOF TY��/ windows): Subtract half tr ;ABLE OR HIPPED ROOF <br /> between the top of the hig with windows): Subtract <br /> �,, / window and the highest pc �alf the distance between <br /> � ��/ p . roof 7e top of the highest <br /> ALL OTHER ROOF TYPE vindow and the highest <br /> >oint of the roof <br /> mansard,etc):No subtrac �LL OTHER ROOF TYPES <br /> ` SUBTRACTION Subtract the distance between t flat mansard,etc):No <br /> �• (BASED ON basemenVcrawl space floor and ;ubtraction. <br /> EXISTING highest existing grade adjacent e distance between the top <br /> �- GRADES) foundation OR 10 feet(whichev� and the highest existing <br /> EQUALS Defined building height adjacent to the foundation. <br /> EQV1kL3 Defined building height <br /> � <br /> Shorelarscf �'sstrict NCCWD Permit �verage Lak�share Setback g�uff <br /> hlf�t� <br /> �es � �o Permit Number. � Yes � No N/A � Yes No <br /> N/A—see attached Setback: <br /> �;; Stormwater Quality Existing Hardcover �roposed <br /> Qverlay District o Fiarc�c�ver Variarrc� �€�quirec� CE1P Required <br /> � Tier circle one ��a and sf} %and s <br /> � ,� �.��(? �•� � Yes No � Yes � No <br /> 1 �' Z j� 3 4 5 -� t�,���� �'�� TYpe�S)• TYpe(s)• <br /> ,� <br /> Updated: January 2015 <br /> z:\forms\plan review checklist 2015.docx <br />