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HomeMy WebLinkAboutBLD2004-00518 MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Review Type: 1 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00518 Received Date: 8/6/2004 SITE ADDRESS: . S STROMBERG AVE PORT TOWNSEND, 98368 APPLICANT: JAMES L CHASE TRUSTEE PHONE: (360)457-6549 CHASE REVOC LIV TRUST 1231 MONROE ST PORT TOWNSEND WA 98368-4431 SUBDIVISION: IRONDALE Block: 145 Lot: 27-30 PARCEL NUMBER: 962114504 Section: 35 Township: 30 N Range: 01 W CONTRACTOR/ JAIME KOZELISKY PHONE: (360)385-3215 DEALER: 1112 S JACOB MILLER RD PORT TOWNSEND WA 98368 Contractor's License WAINS0626 Expires 7/31/2007 INSTALLER: JAIME KOZELISKY WAINS0626 7/31/2007 (360)385-3215 1112 S JACOB MILLER RD PORT TOWNSEND WA 98368 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION: NEW MFH ALSO 120 GAL AG PROPANE TANK TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: SILVERCREST SETBACK: VALUATION 23,000.00 YEAR: 1989 LABOR & INDUSTRIES APPROVAL? SIZE: 45 X 24 BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PUD BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO STORMWATER: YES NO Exist: Exist: AREA Plat Conditions Prop: 2 Prop: 2 Wetland Erosion Total: 2 Total: 2 Seismic Streams Flood Way Floodplain Routing Date: F&W Landslide -ccr Shoreline Aquifer VED Type Amount Paid Bv: Date: Receipt: ppro e a Manufactured Homes $154.00 KAS 08/06/04 66715 SEP 2 2 2004 Potable Water Application $52.00 KAS 08/06/04 66715 Jefferson County Planning Total: $206.00 C & Building Department • • MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD04-00518 Received Date: 8/6/2004 SITE ADDRESS: 72 S STROMBERG AVE Issue Date: 9/22/2004 PORT TOWNSEND, 98368 APPLICANT: DAN BROADBENT 2319 LANDES ST PORT TOWNSEND WA 98368 SUBDIVISION: IRONDALE Block: 145 Lot: 27-30 PARCEL#: 962114504 Section: 35 Township: 30 N Range: 01 W CONTRACTOR/ DEALER INSTALLER: JAIME KOZELISKY WAINS0626 Expires: 7/31/200M 1112 S JACOB MILLER RD PORT TOWNSEND WA 98368 PROJECT DESCRIPTION: NEW MANUFACTURED HOME ALSO 120 GAL AG PROPANE TANK n C` rt °P." Pik:"1.1�r 7 L MAKE: SILVERCREST J-� 30> i''/2A YEAR: 1989 SIZE: 45 X 24 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 9/22/2005. REQUIRED INSPECTIONS: [ ] Setbacks/Footing (CONTINUOUS FOOTING SLAI�r PADS USED): f ] Stormwater FINAL Approval: '-[. ] Blocking/Plumbing: F6 g •v _ [ ] Propane Tank/Lines _ 1 Zoning Final Approval: {, ] Septic System Final Approval: [ .], Road Approach Final Approval: n [/] Final/Skirting/Vents/Porches/Steps: �/K -�a� t'i n.1_i� DES.7 HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. SPECIAL CONDITIONS APPLY- SEE REVERSE HOT-LINE AVAILABLE 24 HOURS A DAY • 9.) Critical Aquifer Recharge Areas may require special protection measures mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 10.) MANDATORY MEASURES FOR COASTAL SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirement: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 11.) This parcel is a legal nonconforming parcel designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 12.) This parcel is served by a public water system (Jefferson County PUD). 13.) A septic permit (SEP04-00190) was approved September 22, 2004 for a capacity of 360 gallons per day. 14.) This parcel was created through the Irondale, Div. No. 6, under AFN 30490 recorded June 28, 1910., LP Volume 2, page 139 in with the Jefferson County Auditor's office. 15.) A Declaration of Restrictive Covenant to combine lots 15 - 18 and lots 27 - 30 of Block 145, Irondale#6 was recorded on September 1, 2004 under AFN 488883. 16.) The building height is not to exceed 35 feet. 17.) Pre-existing legal lots of record less than one acre in size in Rural Residential districts are subject to the stormwater requirements in UDC Section 6.7 and must meet the "Area of Impervious Surface Coverage"to the maximum extent practicable as determined by the Administrator." Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 18.) The minimum setback from S. Stromberg is 20 ft from the property line. The minimum setback from Victory Avenue is 20 ft. from the property line. The setback from the north and south property lines is a minimum of 5 ft. 19.) The site plan as submitted with the manufactured home installation application on August 6, 2004 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated September 22, 2004 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 20.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental Policy Act (SEPA) pursuant to WAC 197-11-800(1)(b)(i). 21.) This approval is for a manufactured home installation only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 22.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 23.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on any lot less than one-half acre unless totally screened from view of neighboring dwellings and rights-of-way. Such screening shall meet all applicable performance and development standards specific to the district in which the storage is kept, and shall be in keeping with the character of the area. Screening shall meet the requirements of Unified Development Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable vehicles is prohibited except in those districts where specified as an automobile wrecking yard or junk (or salvage) yard and allowed as a Permitted Use in Table 3-1 of the UDC, and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area (ESA). 24.) A minimum of two (2) on-site parking spaces are required for the single family residence. • • SPECIAL CONDITIONS CASE # BLD04-00518 1.) S. Stromberg Ave. (P492) is a private road. A road approach (RAP04-00201) was issued and an address of 72 S. Stromberg Ave. has been assigned to the parcel. CONTACT TERRY DUFF AT 360-385-9159 FOR FINAL INSPECTION OF ROAD APPROACH PRIOR TO FINAL BUILDING INSPECTION. 2.) Stormwater shall be retained and infiltrated on site. The owner shall control all sedimentation and erosion on the property. 3.) The applicant is proposing to create or add 1,875 square feet of impervious surface and 20,000 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires the project applicant submit a stormwater plan meeting Minimum Requirements #1 through #5 of the Department of Ecology Stormwater Management Manual for Western Washington. The stormwater plan shall address measures to control stormwater, erosion and sediment during construction and shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 4.) The application was reviewed by the Jefferson County Department of Community Development staff on 8/23/2004 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: Special Aquifer Recharge Area, Coastal Seawater Intrusion Protection Zone 5.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 6.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas (1) All Industrial Land Uses (2) All Commercial Uses (3) All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit (4) All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit (5) Unsewered Planned Rural Residential Developments (6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 7.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according to the County GIS map. There are voluntary and mandatory measures identified in the Jefferson County Seawater Intrusion Policy(Resolution 44-22, effective September 23, 2002) that apply to well drilling proposals and building permit applications on existing lots of record. A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources within 1000 feet. 8.) Marine shorelines and islands are susceptible to a condition that is known as seawater intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater suitable for public consumption without significant additional treatment and cost. Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals (primarily through wells). The Washington Department of Ecology is the agency with statutory authority to regulate groundwater withdrawal for individual wells in Jefferson County. New development, redevelopment, and land use activities on islands and in close proximity to marine shorelines in particular should be developed in such a manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent possible by infiltrating stormwater runoff so that it recharges the aquifer. JE�RSON COUNTY ASSESSOR JACK WESTERM III RSON COUNTY COURTHOUSE ASSESSOR PO BOX 1220,PORT TOWNSEND WA 98368 (360)385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME / MAILING ADDRESS: THIS IS NOTA TAX STATEMENT NAME: it G•'^ `J(sVC''� 9`"1 The purpose of this questionnaire is to obtain information V 1 regarding either the current location of a mobile home or the ADDRESS: c - I 9 ,_ (V`4v' S J previous ownership and location of a mobile home. This will r\)vr k ` D_.y� yy� 1V�✓,- 9 help our office determine whether the mobile home is already V �V on the tax rolls in Jefferson County_or if it has been moved to 9 _ this county frpm another area. Please see reverse side for TELEPHONE NO: 37 ' �'}6 6 p additional information. 1) MOBILE HOME DATA: • (A) MAKE J i VC' Lrn)--- (B) MODEL S A-rc:\ id (C) YEAR 1 99 (D) LENGTH l S 1 (E) WIDTH j t ` (F)SERIAL NUMBER I t J C 5 LI 17 ter" R (G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) a3p Vv (H) PURCHASE DATE 5-//J /0 2) PREVIOUS OWNER / LOCATION OF MOBILE HOME: (A) FROM WHOM DID YOU PURCHASE OBILE J (Avh E `�S�� ADDRESS 6 I S- YO t el(A `l ptf t t oivhV4(� (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?/ 0� YES NO IF NO HAT COUNTY? ) I0 IF YES,WHAT WAS PREVIOUS ADDRESS OF MOBILE? 0 S • d(i- ) UW d1.5F'A 3) WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES T10� (B) IF LOCATED IN A MOBILE HOME PARK: �/ NAME 8i ADDRESS OF PARK SPACE NO. (C) IF NOT LOCATED IN A MOBILE ME PARK: NAME OF LAND OWNER G V\ )r c•' . LOCATION(ADDRESS) (-4-r) sovi. )`\T1)4 k1S REAL PROPERTY PARCEL NUMBER/DESCRIPTION 6.) I ( - ,(V . 1 d2-.1,-----1 THANK YOU FOR YOUR HELP! / SIGNATURE ' dial 49 A_4 KELLI LARSON, 'roperty Technician THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION. sow � g , 06, JEFFERSO�OUNTY •° E [I-- I, DEPARTMENT OF COMMUNITfPJ �' Ii_,_ � o DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 { 360/379-4450 • 360/379-4451 Fax s �! AUG Is,�— ,3 wow.co.jefferson.wa.us/commdevelopment I Jl:r FRcph CO f'�TY Master Permit Application r r; , ,,rzl .:� `opl:Eti" Project Description(include separate sheets as necessary): Tax Parcel Property Number: `1( L i I -/ .50 �/g(.,`l l i-/S Size: �G',C%�a� (acr c re fee Site Address and/or Directions to Prpperty_ ~ Property Owner(s)of Record: •_ • _ �� 6._ Telephone: ' S :5 Fax: •Mailing Address: —` 2 email: Applicant/Agent(if different from owner): , r Telephone: Ec `3 — ?c) Fax: [� email: Mailing Address: '2,3 t9 �--At-+C E� r i f2T k C9c.:a,-„ r _,,1 gp;3 C ens What kind of Permit?(Check each box that applies) Building ❑Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a),C(d),or CJ** ❑Single Family ❑ Discretionary"D"or Unnamed Use Classification x❑Garage Attached/Detached ❑Special Use(Essential Public Facilities)** Manufactured Home ❑ Boundary Line Adjustment ❑Modular ❑ Short Plat** O Commercial* ❑ Binding Site Plan** ❑Change of Use ❑ Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** j\ Propane ❑ Plat Vacation/Alteration** llowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: I hereby designate h Aj DESIGNATION OF AGENT • - � "\ ti l to act as my agent in matters relatin 'to this appli on for ermit s OWNER SIGNATURE Cs�1 GA Date: V-2 8- 0 V `/' �' �/ • By signing this application form, owner/a nt attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's 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 this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court cnsts,reasonable attomey's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit I further agree to pr• '.e act ss of entry to Jefferson County and its employees,representatives review and any r-• :. later i pecti .Acc-ss and right to this ro questdnor agents for the sole purpose of business hours. ' property shall be requested and shall _� only during regular business Signature: _ J Date: U ( 1 The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been'. -.will n violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if . :re in iance with the Jefferson County.development code.The Applicant acknowledges that he,she or it holds individual and non-tr-ansf:� . : res i i a • to and ng with the ESA. The Applicant has read this dij r sand dates it below. x„Signature: \ c J/ i Date: G:\Pen enter\FORMS\DAD FORMS\Master Permit Application 7-8-04.doc NER BUILDER STATEMENT a signer of this statement does hereby certify that they Owners of the parcel referenced herein,that the not licensed contractors_cid that :y will be assuming the responsibility of the General Contractor for the proposed project. gnature: Date: IENERAL CONTRACTO `OR OR MANUFA URED HOME INSTALLER: PHONE:r FAX: tit 1..Q IS 1-;‘t< HZ,MC c,fit#ce (36c ) SS- 1) iC ( ) AILING ADDRESS: ( C I i c) S .3 Alt J. f s 1 k r f-7'I,c,a EMAIL: :ONTRACTOR'S LICENSE WAINS ,, 4UMBER: G / 6 S SO 9 NUMBER UL C#� \RCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ii New 0 Wood Existing: ❑ Sewer 3 Addition 0 Steel Proposed: 7.-- Bank ❑ Community System Total: Z Height: ❑ Individual System � Alteration/Remodel 0 Concrete Y A Repair ❑ Masonry SEP Permit# A PR. SD Fite., A Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: —7— jPublic Total: ___ C Name of System: 4I-EI.1 eswe Sc,. If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: ❑ Underground Tank $8bove ground Tank Size of Propane Tank: f � 4`'' 1�y^\ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other Is this appliance being installed in a Manufactured/Mobile Home? 4411, No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. • ; Square Footage 1 orO ace Use Drily • j, ff ry Current Proposed Amount: _ Main Floor Consistency Reviet 2Nu Floor vi , l , 3`0 Floor i J) - ct.I i. : Seion: Mezzanine: V. A,(3 - L�U' Pla\\ nt' •• fee: Heated Basement State Su • •'fie r,. Pottl er Re ee Unheated Basement s ��;4 I 0r ` ' Other Unheated • r J11/Rd Apj �x ;, Idr, ,�-• V s .`. 4.31 ti lam" ,,. ,,y. . Garage/Carport TQ } R 3 r� , Decks aptNrr L ' ti rky , ! - Other ' . ` ^ ' *..44` 41Y . i . • ESTIMATED COST(REQUIRED) 4 ��,a''.��,� .c -, °,, *Fair market value of all labor and materials foundation to finish y�.� • i t •(, • �'T ' rtu" '' a ' .. q�.i w G:\Pem itCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc a ON liffirN , JEFFERSON COUNTY 414,,1 I DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend•Washington 98368 194X14C1 360/379-4450 • 360/379-4451 Fax http://www.cojefferson.waus/commdevelopment/ us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE muot t1 L./ oLt -o oc 3 6 PROJECT/APPtJCJWT NAME: 1)A v\ CoGat.tt Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separate stormwater site plan map. Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. rx "1--CA 6,(1,[ kome • Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. 3. Discribe the exiting vegqtation. Indicate native vegetation areas on the site map. �(vtS� 4. Describe thq existing soils.li Indicate soil type on the site map. lC Sq_ 5. Describe the existing site hydrology(i.e.,drainage;behavior of water on the site—above,below, and on the ground). Indicate existingstormwater drainage to and from the silo on the site map. Depict separate drainage basins on the site map, if applicable,and indicate acreage of each. Pa%ACtt. ;kIokLA,Art3 \eD WcSt r- 6. Describe any excess levels of noise generated by the proposed use or activity: VI I A— storrry ater site plan template—rev.10/1/2003 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on the site. Indicate location on the site map. 1 r P\ 8. Describe the general vicinity of the site,including adjacent land uses and structures,utilities, roads,and sensitive/critical areas (streams,wetlands,lakes,steep slopes,etc.). Or i A- Permanent Stormwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation.of the appropriate stormwater control BMPs and facilities to remain in place after construction of the project is completed. "Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious surfaces, and pollution-generating pervious surfaces to•verify that the thresholds for treatment facilities and flow control facilities are not exceeded. g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed(i.e.,per BMP T5.30 in the Manual)or,if not,what types of stormwater flow control will be utilized for the site or specific threshold discharge areas oi within�th�site�Locate thes NI �G i�ie`s on the site plat'and diff S-covvt\ TO 5 ��er>�at)e p ed foci fro�exis�g�apilities. k y • 10. If the project requires the use of stormwater treatment fealties,describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for large"projects or projects that involve the potential for dispersion of contaminants.] , ./i i f t 11. Describe the performance goals andt standardsl_ applicable to the project. \-01.(m1 W`1' Cf wi\, loci -i el C, 1 1 i-tk c\IA Si ke 12. Describe the flow control system. \\I ik- 6 storrnwaler site pan template—rev.1 Q'12063 Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems,treatment facilities,flow control facilities,or structural source control BMPs (not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan ("as-builts')when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the bes my knowledge. I also certify that this application is being made with the full knowledge and consent of all own o the a ect property. /? o ( NER OR AUTHORIZED ES SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED: 12 stormwater site plan template—rev.7012003 0 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. ` v A_ 9. Control Pollutants. \.) 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Management Prlactices(BMPs). w� bt Y1a�c�-S � rutt`‘ hC C6n1trkC{,e� 12. Manage the Project. vv i (t q4 r e%'rt �►-o f of 1( \\F Se,5 b k 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). �f VI "virtu C✓l r b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). \\./ (1-- 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. /•(. ' stormwater site pan template—rev.101/2003 9 b. Description of special requirements for working in or near environmentally sensitive areas. \ J (47i-- Erosion Problem 4. Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure). \\\I '/k 5. Construction Phasing. a. Construction sequp k C @ c l Icy- . I Pk s i-9 ‘1 rflo i ' t6 rile 101 CS c4 eC b. Construction phasing(if proposed) A 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Pr vide a ptOped to ion ul t eq 0 U cl t6 k�vA VO4 A 1, Ge�.a b Qh4 ok 0( 064/ . y II. Wet Season Construction Activities. a. çroPosedeseon constructiock actiyities.. b. Propo sei wet season construction activities for environmentallysensitive areas. i\J A-- 7. Financial/Ownership Responsibilities. a. Identify the Perty wer�for the initiation of bonds and/or other financial securities. — b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. \,) IA--- . d. Runoff/Stormwater Detention Ca 'ulations 10 stone eater site plan template—rev.10/1/2003 • 13. Describe the water quality system. f J _ 14. Describe the conveyance system analysis and design. 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. Y16111Q 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. /fir • 17. Describe the proposed urf material. Ikook vyky iccks LA c\,,xarc.,i, S Litt 11_,S -crovki--.),04 18. Describe methods for restoration of the site. (CrIa\SCcTIAC) 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals here. i 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. 1\i" 21. List other necessary permits and approvals as required by other regulatory agencies. ff those permits or approvals include conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or restrictions here. /(1.- stormwater site plan terrptate—rev.10/1/2003 CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION—TI I—CONSTRUCTION SWPPP NARRATIVE 1. -'Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. C 661 611 ITS e Mat l'At4 2. Establish Construction Access. o e ccts e(tirrk titirs1 f 3. Control Flow Rates. USA 5 Ctxw W1't \V o, S to e e, 4. Install Sediment Controls. !VOA 1C1A 5. Stabilize Soils. (ASQ S)fa+v- aid M( (L ec v4 6. Protect Slopes. j 1/- 7. Protect Drain Inlets.S kfcw G " a (Att.! Ctth 8 stormwater site plan template—rev.16'11200,3 ..... RETURN ADDRESS tYASNINSTIN STATE DEPARTMENT Of Manufactured Home C. LICENSING ®TITLE ELIMINATION Application ❑TRANSFER IN LOCATION ❑REMOVAL FROM REAL PROPERTY Anyone who knowingly makes a false statement of a material fact is guilty of a felony,and upon conviction may be punished by a fine,imprisonment,or both. (RCW 46.12.210) D MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) <01792 1989 SILVC 44/24 AB7SC5417OR © LAND LEGAL DESCRIPTION ON PAGE 2 MANUFACTURED HOME WILL BE ®AFFIXED 0 REMOVED REAL PROPERTY TAX PARCEL NUMBER 962114504 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION 15 To 18&27 To 30 145 Irondale Division No.6 © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 2 1 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Kurt Lamberton NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Patricia Lamberton ADDRESS CITY STATE ZIP CODE 2456 Seaview Drive Port Townsend WA 98368 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE GRANTEE NAME Kurt Lamberton and Patricia Lamberton I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title,IF APPLICABLE Signature of Additional Registered Owner and Title,IF APPLICABLE NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE State of Washington Signed or attested County of Jefferson before me on by Kurt Lamberton Signature PRINTED NAME OF REGISTERED OWNER NOTARY OR AGENT by Patricia Lamberton PRINTED NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Office No.OR Title Notary Public AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date D TITLE COMPANY CERTIFICATION I certify that the legal description of the land and ownership is true and correct per the real property records. NAME(TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER SIGNATURE/POSITION DATE Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. © BUILDING PERMIT OFFICE CERTIFICATION I certify that• the manufactured home has been affixed to the real property as described. a building permit has beenissued for this purpose and the attachment will be inspected upon[ completion. 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