HomeMy WebLinkAboutBLD1992-00205 JEFFERSON COUNTY
UNIVERSAL PLOT PLAN
(This is not a permit)
Fill in the following information as completely as possible
Use N/A where the question is not applicable.
Property owner name:
Authorized Rep/Contractor/Developer:
1
JERRY & JANET NAFZIGER NONE AT THIS TIME
Mailing Address: Contact Phone:
19041 N.E. 151ST. Address:
WOODINVILLE, WA zip code
Site Address/911#:
POTABLE WATER SOURCE: check one
zip code ' C< Public Supply
Mile Post # 0 Port Townsend
Phone# 0 PUD
x3x Other
work: 867-1074 Name: BRIDGEHAVEN
home: 867-1574 State I.D: 08330N
Private Supply
LEGAL DESCRIPTION:
Drilled Well
9 Digit Parcel # 935-700-015 Other
Section 16 Township 27 Range NORTH RAND -ZAS4,_ = T
Govt. Lot # Tax # 1-49F3H2L1 OFFICE USE ONLY
Planning Area Fire Dist.
Plat/Tract/Addition LOT 16 OF School Dist.
BRIDGEHAVEN Area/Division # 7 Land Use Designation
Block # Lot # 16 Shoreline Designation
Parcel Area/Size 12 , 288 SQ FT Project Use:
Proposed Subdivision Name J
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Shoreline Setback�, � �O Signatur
Bank Height'f , , C' Date
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