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. , _ PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS <br /> Address: /q-5-3 /1/0/'7'1i AV el( Permit No.: r7-0i17- Oa <br /> Description of work: 1/(//t t1 (1(0 t/ d f..e( aS Date Rec'd: R/. -5/1/7 <br /> Septic review by: Date Approved: <br /> Zoning review by: /7 Date Approved: <br /> jie.,X <br /> Building review by: r/.-- /t ( Date Approved: e0/7// 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/1 Width: Structural Coverage: SF % <br /> Survey Submitted: 0 Yes ,O No Date of Survey: Revised date(?): <br /> Landscape plan submitted? 0 Yes\ Landscaper: 0 No/ None proposed <br /> Proposed Setbacks: <br /> Front(Lake) Rear(Street) ( N S E W ) ( N S E W ) Other Buildings Wetland <br /> Side Side <br /> Building Height Analysis: <br /> Distance Between First Floor and defined Top of (a) <br /> Roof* (See "building height" definition): <br /> First Floor Elevation (frobuilding plans): (b) <br /> Highest Existing ground I vel (per survey) or 10' (c) <br /> above lowest ground leve , whichever is lower: <br /> Difference between (b) an (c): (d) <br /> DEFINED HEIGHT If highest existing grade is: (e) <br /> above FFE-Height is(a)-(di <br /> below FFE-Height is(a)+(d) — <br /> Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> 0 Yes 0 No Permit Number: / 0 Yes 0 No 0 N/A 0 YesNo 0 <br /> 0 N/A-see attache Setback: <br /> Stormwater Quality Existing \,Proposed <br /> Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> (circle one) (% and sf) _ (% and sf) <br /> • <br /> 0 Yes 0 No 0 Yes 0 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 />