Complete Application - 20220429 Anacortes RC - MUP Application

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Master Land Use Permit Application Updated October 2021 Page 2 of 4 SEWAGE DISPOSAL: City of Anacortes  Septic ROAD ACCESS: City Road  State Highway Private Road CRITICAL AREAS OR BUFFERS ON SITE OR WITHIN 300 FEET: Yes*No Unknown *If yes, please complete the Critical Area Identification Form SHORELINES WITHIN 200 FEET: Yes / Name:_____________________________  No FLOODPLAIN: Flood Zone: FIRM Panel # Date of Panel: LOT COVERAGE AREA CALCULATIONS: Existing Square Footage: Proposed Square Footage: IMPERVIOUS SURFACE AREA CALCULATIONS: Existing Impervious Square Footage: New Impervious Surface: DESCRIPTION OF SUBJECT PROPOSAL: Additional pages attached PROPOSED WORK: __ _________ _________ _________ _________ _____________________________________________________________________________________________________ _________________________________________________________________________________________________ PROPERTY OWNER INFORMATION: Multiple owners attached NAME: MAILING ADDRESS: CITY, STATE, ZIP: PHONE #: FAX #: EMAIL ADDRESS: APPLICANT INFORMATION: Same as property owner NAME: MAILING ADDRESS: CITY, STATE, ZIP: PHONE #: FAX #: EMAIL ADDRESS: CONTACT PERSON: Same as property owner Same as applicant NAME: MAILING ADDRESS: CITY, STATE, ZIP: PHONE #: FAX #: EMAIL ADDRESS: