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PLAN REVIEW <br /> �ICHECKLIST FOR NEW STRUCTURES / ADDITIONS <br /> 3 <br /> Address: '1Cpd N omh uT1 Y Permit No.: <br /> Description of work: (!�� Date Rec'd: 5 �S <br /> Septic review by: �. V� l u Date Approved: <br /> Zoning review by: Date Approved: Y <br /> Building review by: Date Approved: �7 1 <br /> Grading review by: Date Approved: <br /> Zoning District: ���� Zoning File M <br /> Resolution? Yes GReso M Reso Date: Signed: Yes No Resolution I N <br /> Zoning: Lot Area: ✓ S /AC Width: Structural Coverage: 2 SF l� <br /> Survey Submitted: es 0 No Date of Survey: ,C5 i Z— k4evised date(?): <br /> Landscape plan submitted? 0 Yes Landscaper: Oone proposed <br /> Proposed Setbacks: <br /> i0 <br /> Front e) Rear(Str ( N S E( ) ( N S W ) Other Buildings Wetland <br /> Side Si e <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 building plans): (b) <br /> Highest Existing ground level urvey) or 10' (c) <br /> above lowest round I , whichever is lower: <br /> Difference bet b and (c): (d) <br /> Defin d Build i ng Height(a) -(d): e) <br /> Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> es 0 No Permit Number: 0 Yes 0 No 0 Ye No <br /> /A—see attached Setback: <br /> Stormwater Quality Existing Proposed <br /> Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> circle one % ands % and sfll <br /> / <br /> 1 2 3 4 5 <br /> 1(0,3-7Z(-) (�P�(0 "6J 0 Yes PKNo 0 Yes No <br /> F 7 Type(s): Type(s): <br /> Updated: October 2016 <br /> v:\forms\plan review checklist 10-2016.docx <br />