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PRE-APPLICATION CONFERENCE HELD?: WATER SOURCE: <br /> I❑ Yes,the City file#is .3:1 No City of Anacortes 0 Private Well ❑ Community Well <br /> Master Land Use Permit Application <br /> SEWAGE DISPOSAL: ROAD ACCESS: <br /> JR' City of Anacortes 0 Septic T City Road 0 State Highway 0 Private Road <br /> CRITICAL AREAS OR BUFFERS ON SITE OR WITHIN 300 SHORELINES WITHIN 200 FEET: <br /> FEET: N Yes/Name: PU R-A- JOUrJ> 0 No <br /> O Yes* No ❑ Unknown! <br /> *If yes,please complete the Critical Area Identification <br /> Form <br /> FLOODPLAIN: <br /> Flood Zone: FIRM Panel# Date of Panel: <br /> LOT COVERAGE AREA CALCULATIONS: <br /> Existing Square Footage: j C1Z.� H. Proposed Square Footage: i QZ &/T <br /> IMPERVIOUS SURFACE AREA CALCULATIONS: <br /> (Existing Impervious Square Footage: New Impervious Surface: <br /> DESCRIPTION OF SUBJECT PROPOSAL: El Additional pages attached <br /> PROPOSED WORK: <br /> T+Fc vvo 044. 8EI ►v PQ-0(305p_c) I5 Ea _ P a-K C_Esv,(' <br /> rll�E \P- ?IT S t'NIITS1 N1Et"J PG 12-iN (75 es. N `L 1.0-w <br /> PVC UZ-E {�JTS AND wE 2E PLP\NNIN mac- Fji F ikt RJA/ S <br /> VSI N T 5��1� 1(- /� f�1 rifv4 7tiE AEAc • Pi) R-KK5 C1 W <br /> \ I\Li_ vs M I N i 4.&&C VAT -ctk14 our IKE 0I-9 )(2-'L <br /> 4-'►15 ivy U w►LL K GE P t u) A-r.r' ari hf2-P`'S Al ND <br /> 0 Fr-- -rtE .SEA-c 14 <br /> PROPERTY OWNER INFORMATION: Cl Multiple owners attached <br /> NAME: MAILING ADDRESS: <br /> C-A-N N P\C dv.=c-E 5 P d • 8o X 5�7 <br /> CITY,STATE,ZIP: PHONE#: <br /> AN P\Lo a--r--5, P\ cl 3 b o - z 9q -- 19 b� <br /> FAX#: EMAIL ADDRESS: n } C,o �.1 °� C i 0 c-'0,na,(J6-±-Q5, or }, <br /> I APPLICANT INFORMATION: a Same as property owner <br /> NAME: MAILING ADDRESS: <br /> Updated October 2021 Page 2 of 5 <br />