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:.ppl i c:int ` c :;3r.icIAC:0Al0{,t'n^/ Atldress /° a. 4oX Jrlf �q
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(wor/)
Phone (home) �37 7 7.4x 2-3
Location (legal description) S / 9 T -t7 N R/tr 3 0 Ci OAA 8,9/ l�
Building —
-"Parcel Number
Adjacent Water Body- o/i &4y
the most waterward side of the proposed structure must be set
back att least feet from the theinformation, he high water mark
-
(f U- feet from the edge of the bluff or bank
not 'ableto be determined without additional information
Additional comments: -
11� 4 - - At/6-• /t /y8'�
Signature, Jefferson County Shorelines
Administrator
Jefferson County planning & Building Dept.
County Courthouse
Port Townsend, WA 98368
385-1427
-- .C.,.Te/zH r oi"9><
_-- - -�juff stability ,
o 1 Bluff or Bank h e i gh t
Adjacent
ent "residential Structures within 300 feet? yes no
If yes, existing setback of adjacent homes:
Home t2:
Home $1:
foot setback from bank
foot setback from bankd , propel
_ � �`.` - - _ foot distance from applicant' s
_ _ not _distance from applicants proper��, - - -
Much of the above znf ormation is supplied by the applicant_ Should any information be--
inaccurate, this setback requirement may be changed_
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