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Home My WebLink About01 FormsAulhenlisign ID: 33E95932-96F5-ED11-907A-6045BDD47FEA DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, \N"A 9S368 Tel: 160.379.4450 1 F" iN: 360.379.4451 .+ Li %X eU: ��.cn.icl%rtc+n.u-a.css/cu»nnunii}detielu L-mail_ plannine r'co.ieffcrSVn.wa.w SCAN (01H SiJPPLEMENTAL APPLICATION SHORELINE DEVELOPMENT A completed application form is a requirement of submittal. Include "N/A" in spaces that do not apply. MLA #f Application Type (select one): Statement of Exemotion: lu' of application 1) 2) Case #i Variance* Conditional Use (administrative)* U Substantial Development* ❑ Conditional Use (discretionary)* Does your proposal require in water work and/or works below ordinary high-water mark? Yes 0 No LI= D Does your proposal require 1 000 sq/ft or more of impervious surface and/or non -single-family structures of 5,000 sq/ft or more? Yes 4_= No Q.XJ ' If either of the boxes for 1 or 2 above are checked yes or if the permit type above has an asterisk then a re a fig c conference is required prior to submitting for a shoreline permit. Site Information Assessor Tax Parcel#: 1701164005 , Name ofBody ofWater: FDabob Bay Property Owner Name(s): Richard & Renee Rathvon Project Description Describe the existing property use and condition: Vacant land / recreational use Proposed distance from ordinary high watermark to use/development: I 160 Describe the proposed property use: Single Family Residence with onsite septic and drilled well feet By signing this application form, tip, owner/agent attests tNi, the information provided herein, and in any attachments, is true and correct to the best of his or her knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in ma ''any4ssued�%permit null and void. Owner Signature: C Ard Da�AW Date: 05/ i$123 DI Print Names Richard Rathvon Aufhewisign ID: 33E95932-96F5-ED11-907A-6045B0D47FEA These activities require a formal statement of Exemption issued by Jefferson Count . Check 'Statement of Exemption' box on the front of this form and submit with Permit Application to apply for your Exemption Approval. 18.25.570 Statement of Exemptions (1) The administrator is hereby authorized to grant or deny requests for statements of exemption from the shoreline substantial development permit requirement for uses and developments within shorelines that are specifically listed above. Such statements shall be applied for on forms provided by the administrator. The statement shall be in writing and shall indicate the specific exemption of this program that is being applied to the development, and shall provide a summary of the administrator's analysis of the consistency of the project with this program and the Act. As appropriate, such statements of exemptions shall contain conditions and/or mitigating measures of approval to achieve consistency and compliance with the provisions of this program and Act. A denial of an exemption shall be in writing and shall identify the reason(s) for the denial. The administrator's actions on the issuance of a statement of exemption or a denial are subject to appeal pursuant to the appeal provisions in Article X of this chapter. 18.25.560 Exemptions listed — This is a summary from JCC18.25.560, please review the code section for detailed information regarding these exemptions. (1) Fair Market Value. (2) Maintenance and Repair. (3) Residential Bulkhead. (4) Emergency Construction. (5) Agriculture. (6) Drainage. (7) Navigation Aids. (8) Single -Family Residences. (9) Residential Docks. (10) Irrigation. (11) State Property. (12) Energy Facilities. (13) Site Exploration. (14) Noxious Weeds. (15) Watershed Restoration. (16) Watershed restoration project' (17) Watershed restoration plan" (18) A public or private project, the primary purpose of which is to improvefish or wildlife habitat or fish passage. OFFICE USE ONLY Shoreline Development Permit Fees v Type I Exemption DCD117 ($i49.00i Type II Conditional Use — Administrative DCD117 J' i 1 O0) Type II Conditional Use — Discretionary DCD117 t51, 71 . O) Type III Substantial Development DC1017 Type III Variance DCD1171,$2,247.00) Notice of Application; All type II and III ($149.00 Notice of Hearing; All type III (t 149., If'; Notice Board; All t)" Il and III ($1)M) Scan DCD122 ($26 75) SEPA; if required per CAM or PRE DCD121 Hearing Examiner if required CAM or PRE DCD102 Subtotal TechnoloRv Fee EH9999 — 5% Total Fees* *Additional fees may apply. .5 Authentisign ID: 33E95932-95F5-ED11-907A-6046BDD47FEA MLA # DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port To,;N•nsend, WA 98368 Tel:360.379.4450 Fax.360379.4451 _ Web: hXdove enr �G ti E-mail: dcd[cg i •Tfcrsun.'+=1.1.1_s I',) ' 1 N G11\Q SUPPLEMENTAL APPLICATION CONDITIONAL USE PROJECT/APPLICANT NAME: Richard Rathvon The purpose of the conditional use permit process is to provide flexibility in the application of the use regulations contained in the Jefferson County Code (JCC). No conditional use permit can be granted unless consistency with the performance standards of JCC 18.20, the development standards of JCC 18.30, the procedural requirements of JCC 18.40.280. and the approval criteria of JCC 18.40.530, and other applicable requirements of the UDC have been satisfied. Approval of the conditional use is effective for three (3) years from the date of original approval. If a building permit has not been issued within the three (3) year period, the conditional use approval will expire. The following questions will assist in the evaluation of the conditional use request: Describe the re uested conditional use. ,onstruction of residential dwelling 2- Explain how the conditional use is harmonious and appropriate in design, character and appearance with the existing or intended character and quality of development in the vicinity and with the physical characteristics of the sub'ect ro ert . Proposed SFR has been designed to be constructed 160' from the OHWM as such, the home will sit within the existing mature forest creating an in -forest design resulting in a barely visible footprint. 3. Describe the infrastructure including but not limited to roads, fire protection, water, wastewater disposal, and stormwater control which will serve the requested conditional use. he existing road I driveway was constructed 40-- years ago with consistent use and maintenance since construction Stormwater will be naturally dispersed into the native forest as it always has with no change or increased impact. Fire protection shall be provided by the local fire district in accordance with rural guidlines. Potable water will be Supplied by a private well. Wastewater shall be treated with proposed OSS. Stormwater resulting from impervious cin Irrt irac iRill riicnear¢o n�1iraltii 4. Describe the location, size, and height of buildings. structures, si ina le. walls and fences, and screenint vegetation for the use. SFR & garage will be placed 160' + from the OHWM and shall not be higher than 30' from the highest grade at the house footprint. Proposed SFR will be approximately 3,500 sqft. SFR I garage will be screened naturally by the existing forest. 5. Describe any noise, smoke, dust, fumes, vibrations, odors, outdoor lights or other impacts will be generated by the conditional use. jAny impacts such as noise, dust, fumes etc. should be considered 'as typical' for constuction and end use of a SFR. 6. Describe the -pedestrian and vehicular traffic and earking area assaclaled with the : ar,dilional use. Existing road / driveway is a dead end private gravel road with only one user beyond the proposed SFR. There is no pedestrian use. Page 3 Aulhenlisign ID: 33E95932-95F5-ED11-907A-60459DD47FEA Will the proposed conditional use result in the siting of an incompatible use ad acent of an air ort or airfield? 8. Are there any significant adverse impacts on the human and natural environments caused directly by the conditional use? If yes, I can these imoacts be mitigated? 9. Describe how granting the conditional use will not be materially detrimental to uses or property in the vicinity of the subject parcel. 2 adjacent parcels are currently used in the same manner as our proposal outlines Describe how granting the conditional use will not he SLAOstartlally detrimental to the public interest. 'he public will have no relationship to this proposal due to the fact that there is no public access to or near this parcel nd the visibility of the proposed SFR from the waters of Dabob Bay will be very minimal. 11, I Does the conditional use have merit and value for the community as a whole? 12. Describe how the conditional use complies with all other applicable criteria and standards of the Jefferson County Code (JCC) and any other applicable local, state or federal law; and more specifically, conforms to the standards contained in JCC 18.20 and JCC 18.30. The septic permit has been submitted to Jeffco EH, and the well permit will be submitted to Jeffco EH at a later date. 13. 1 Describe how the conditional use is consistent with all relevant goals and policies of the Jefferson 10ur proposal is consistent with zoning and the existing use of properties in the vicinity ACKNOWLEDGEMENT Plan. By signing the application form, the applicantlowner attests that the iriformation provided herein is true and correct to the best of his/her knowledge. Any material falsehood or any omission of a material fact made by the applicanVowner with respect to this application packet may result in this permit being null and void. ki0AAVW RAtAvoh (APPLICANT OR AUTHORIZED REPRESENTATIVE SIGNATURE) N[ OTE: Representative authorization is required if application is not signed by the Owner.] (DATE) 05/18/23 Page 4