HomeMy WebLinkAboutBLD2004-00533 kel
a MLA04-00499
Review Type: I
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD04-00533 Received Date: 8/18/2004
SITE ADDRESS: 181 EMBODY RD
PORT LUDLOW, 98365
APPLICANT: DOMINIC J SVORNICH PHONE: (360)437-0564
181 LUDLOW BAY RD
PORT LUDLOW WA 98365
SUBDIVISION: MARSH AND MEADOW SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 801124011 Section: 12 Township: 28 N Range: 01 W
CONTRACTOR/ OWNER/BUILDER PHONE:
DEALER:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION: NEW MANUFACTURED HOME
TYPE OF WORK MOB / MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW—
S
VALUATION 66,445.00 I L7 MAKE: KARSTEN SETBACK:
)� YEAR: 2005
LABOR & INDUSTRIES APPROVAL?
SIZE: 64 X 28 BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO
Exist: Exist: STORMWATER: YES NO
Prop: 3 Prop: 2 AREA Plat Conditions
Total: 3 Total: 2 Wetland Erosion
Seismic Streams
Flood Way Floodplain
Routing Date: � / ,Li � F&W Landslide
V
c ;j Shoreline Aquifer
Type Amount Paid By: Date: Receipt: , A�Nu' ^ur�e�l rti
Permit $154.00 ZAN 08/18/04 66726 5 2004
—
Potable Water Application $52.00 ZAN 08/18/04 66726 OCT
Total: $206.00 Jefferson County Planninc;
& Building Departm nt
•
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#: BLD04-00533 Received Date: 8/18/2004
SITE ADDRESS: 181 EMBODY RD Issue Date: 10/5/2004
PORT LUDLOW, 98365
APPLICANT: DOMINIC J SVORNICH
181 LUDLOW BAY RD
PORT LUDLOW WA 98365
SUBDIVISION: MARSH AND MEADOW SHORT PLAT Block:
Lot: 1
PARCEL#: 801124011 Section: 12 Township: 28 N Range: 01 W
CONTRACTOR/ OWNER/BUILDER PHONE:
DEALER
PROJECT DESCRIPTION: NEW MANUFACTURED HOME
MAKE: KARSTEN
YEAR: 2005
SIZE: 64 X 28
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 10/5/2005.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. :
Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED) °'^�Lk` k7-6 ---e5t
Stormwater FINAL Approval:
Blocking/Plumbing: EboCK►NG j E.120w og.td 'eorldrivem 17-pi f_k
--
Propane Tank/Lines_ _NA
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval: _ A rWa .,
Final/Skirting/Vents/Porches/Step � oZ 1j =
HEALTH DEPARTMENT AND PU LIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT-LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY- SEE REVERSE
• •
SPECIAL CONDITIONS CASE # BLD04-00533
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on September 1, 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, the following ESAs were
confirmed to be present on the subject property: wetland, Susceptable Aquifer Recharge
Area, Frequently Flooded Area, Seisimic Hazard, Type 3 Fish Bearing Stream.
2.) 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.
3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
4.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type,
geologic material, and groundwater that may combine to create problems with slope
stability, erosion, and water quality during and after construction or during natural events
such as earthquakes or severe rainstorms.
5.) Wetland and stream buffers are areas that shall be maintained in their natural condition,
however, minor pruning or alteration of vegetation may be permitted as long as the
function and character of the buffer are not diminished.
( v A permanent physical separation along the upland boundary of the wetland buffer area
shall be installed and permanently maintained. Such separation can include installing
logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC
Administrator.
7. Wetland buffer perimeters shall be marked with temporary signs at an interval of one per
parcel or every one hundred (100) feet, whichever is less. Signs shall contain the
following statement: "Wetland & Buffer- Do Not Remove or Alter Existing Vegetation."
=j' The applicant is proposing to create or add 1,750 square feet of impervious surface and
3,664 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 Ian shall address
measures to control stormwater, erosion and sediment d st ction and s a
address permanent measures to stali exposed-cluriny construction, anchor the=-a.
deign and operation -stormwater and drainage Dntrol systems
9.) 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).
10.) The revised site plan as submitted on September 29, 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 October 4, 2004 shall be resubmitted for review and approval by
Jefferson County Department of Community Development.
Per this site plan the manufactured home is within the "building site" as shown on the
Marsh and Meadows Short Plat (AFN 432690).
11.) This approval is for a manufactured home 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.
12.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
13.) Not more than two (2) unlice ed or inoperable vehicles shall be stored oginy 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).
14.) Maximum lot coverage is not to exceed 10%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
15.) The building height is not to exceed 35 feet.
16.) Setback from Embody Rd. right-of-way is no less than 20 ft., setback from access
easement right-of way is no less than 20 ft., side and rear setbacks are no less than 5 ft.
If an environmentally sensitive area (ESA) is present, then the more restrictive setback
shall apply.
17.) This parcel is a legal non-conforming parcel designated as Commercial Agricultural 1:20
under the Jefferson County Comprehensive Plan Land Use Map effective August 28,
1998.
18.) Embody Rd. (C512809) is a county road. A road approach was reviewed under
RAP04-00181. An address of 181 Embody Rd. has been assigned to the parcel.
19.) A minimum of two (2) on-site parking spaces are required for the single family residence.
20.) This parcel was created through the Marsh and Meadows Short Plat under AFN 432690,
recorded April 10, 2000, Volume 4, pages 129-130 in with the Jefferson County Auditor's
office.
21.) There shall be no disturbance of soil or vegetation within the streams and wetlands
including their associated buffers of any sort, including the prohibition of livestock grazing
and vehicular access. The buffers are marked with fencing and signs.
22.) All construction activities shall not encroach upon the wetland and stream buffer. This
includes the storage or preparation of materials.
23.) ; Wetland buffer perimeters shall be marked with temporary signs at an interval of one per
parcel or every one hundred (100) feet, whichever is less. Signs shall contain the
following statement: "Wetland & Buffer- Do Not Remove or Alter Existing Vegetation."
24.) A permanent physical separation along the upland boundary of the wetland buffer area
shall be installed and permanently maintained. Such separation can include installing
logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC
Administrator.
JEFFERSON COUNTY ASSESSOR
JACK WESTEWAN III JEFFERSON COUNTY COURTHOUSE
ASSESS R 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: �O0, 10+e-• . � • �v��J�C�1k
The purpose of this questionnaire is to obtain information
regarding either the current location of a mobile home or the
ADDRESS: t(r ��`t� previous ownership and location of a mobile home. This will
lug �q help our office determine whether the mobile home is already
0 on the tax rolls in Jefferson County_or if it has been moved to
this county frpm another area. Please see reverse side for
TELEPHONE NO: ,c..1,MT7 OS 4 94 additional information.
1) MOBILE HOME DATA:
(A) MAKE KA'c'Ir�ki (B) MODEL Kb 6L(OVS O
) { (C) YEAR Z-
L
(D) LENGTH 6y (E) WIDTH Z (F)SERIAL NUMBER 2 G yZ
// //,^� ,C�
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(G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) V V '1 py (, ,o¢t
� (H) PURCHASE DATE i
2) PREVIOUS OWNER / LOCATION OF MOBILE HOME:
(A) FROM WHOM DID YOU PURCHASE MOBILE N /PA — N E u J
ADDRESS
(B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES NO (IF NO,WHAT COUNTY?
IF YES,WHAT WAS PREVIOUS ADDRESS OF MOBILE? .,
3) WHERE MOBILE HOME IS TO BE LOCATED: i
AUG 1 2004 L
(A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES NO
(B) IF LOCATED IN A MOBILE HOME PARK: JEFFERSON COUNTY
NAME 8i ADDRESS OF PARK DEPT. OF COI,MUITY DEVELOPM1=_N_
SPACE NO.
(C) IF NOT LOCATED IN A MOBILE HOME PARK:
NAME OF LAND OWNER: .1)0'M SV 0 U-Jt
LOCATION (ADDRESS) l D\ E\MG'o LLOo in65
REAL PROPERTY PARCEL NUMBER/DESCRIPTION mARSit t ivlipttrot4 Skc Lr ct 1 �e j 'i. #`�c)il7,�r:l0!1
al
St/FX, iv :0Kv e• CT-2iOtte>+ S .— Coicf;C-1. IkS F.5&1— F 43Z(g Zq
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THANK YOU FOR YOUR HELP! II 1
SIGNATUR��
KELLI LARSON, roperty Technician
THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION.
JEFFERSON COUNOOMMUNITY DEVELOPMENT 621 SHERIDAI , PORT TOWNSEND WA 98368
MANUFACTURED HOME INSTALLATION PERMIT APPLICATION
NEW BUILDING REPLACEMENT \--_i , . ,„, E
1SIZE "n GLYEAR 2 0,3SAUG '. E 2004
\B
MAKE KRCST ..'- 4.Otfre_ JEFFERSON COUNTY
DEP1. OF COMMUNITY DEVELOPMENT
COST 66 t 40t5
BEDROOMS: BATHROOMS: TYPE OF HEAT: _
EXISTING 0 EXISTING �Electricity ❑ Oil
PROPOSED .3 PROPOSED 2- 0 Woodstove 0 Propane
TOTAL TOTAL L 0 Heat Pump 0 Other
TYPE OF SEWAGE DISPOSAL: WATER SUPPLY:
❑ SEWER 0 COMMUNITY SYSTEM )4 PRIVATE WELL 0 TWO PARTY WELL
INDIVIDUAL SYSTEM 0 Conventional 0 PUBLIC Name of water system:
PERMIT # SEP On A 0674LX Alternative
IF WATERFRONT PROPERTY,
DISTANCE TO BANK OR HIGH WATER LINE ft BANK HEIGHT ft
By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge.
Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit
being null and void.
I further agree to save, ind:mnify and hold harmless Jefferson County against all liabilities,judgments, court costs, reasonable attomey's fees and
expenses which may in any ay accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provid-. e.s and right of entry to Jefferson County and it's employees, representatives or agents for the purpose of application
review and any required 1 - nspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during
regular business h'. . Iim
SIGNATURE DATE g'1 .cm
NAME (PLEASE PRIN jTvl‘Ub v 1-. Svoe ..sq. y
FOR OFFICE USE ONLY r
CONSISTENCY REVIEW FEE 4%.Ob RECEIPT# fp OZ..
BASE FEE I . w CASH/CK# (5
-
5
ADDITIONAL SECTIONS 6 DATE _/ j Df.
POTABLE WATER Z40 11
911/ROAD APPROACH RSA' oq In
PROPANE TANK 0
TOTAL �V
CI,
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JEFFERSON COUNTY -P
DEFT.OF COMMUNITY DEVELOPMENT
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14,1 DEPARTMENT OF COMMUNITY DEVELOPMENT Jti i t5Er _ 7 iI
,, . 621 Sheridan Street • Port Townsend •Washington 98368 L� '-w
O 360/379-4450 • 360/379-4451 Fax
G' http://www.co.jefferson.wa.us/commdevelo ment/ Jrr Ch ,C� C^ri1 t�-- 9
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STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# ...E.fls _)' 0.-)" r\ PROJECT/APPLICANT NAME: , l'';r;r,,.4. 4'
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. <•-'
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Existing Conditions Summary yy._��
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2. Describe the existing topography. Indicate contours on the site map. F� t�
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3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
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4. Describe the existing soils. Indicate soil type on the site map.
5. Describe the existing site hydrology(i.e., drainage;behavior of water on the site-above,below, and on the ground). Indicate
existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if
applicable,and indicate acreage of each.
6. Describe any excess levels of noise generated by the proposed use or activity:
\l /
5
stormwater 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.
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.).
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.
9. 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
within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities.
10. If the project requires the use of stormwater treatment facilities, 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.]
11. Describe the performance goals and standards applicable to the project.
12. Describe the flow control system.
stormwater site plan template—rev.10✓1l2003
6
Stormwater Site Plan i f l _ !`I x#801124011
Qi:181 Embody Rd U �,�F _ ML MLA04-00499 c;,
Port Ludlow, WA 98365 i C`se BLD04-00533 -1
Jr:i f EI;SUN COUNTY
DEPT. Or COS.IMUN'I(YDEVELOPMENT �.-.
1. Project Overview
c.�
The purpose of this project is to install a sand filter septic system and install a single family
manufactured home. Once developed, natural features of the site will be unaffected, and tot4 y
impervious surfaces will amount to the square footage of the home (1707 sq.ft.). a O cc
2-8. Existing Conditions Summary
2. The 1.56 acre building site is generally level. The staked septic drain-field area is also level,
but at a slight elevation (approx. 2 feet)from the home site. See contour lines on map.
3. Inside the 1.56 acre building site, vegetation is limited to old fruit trees, grass, thistle, and
blackberries. Beyond the buffer zone and bordering the stream on the western edge of the lot
there are many tall marsh grasses and trees, primarily Alnus rubra(Red Alder), Corpus
stolonifera (Red Osier Dogwood), Picea sitchensis(Sitka Spruce), Saliz lasiandra(Pacific Willow)
and Saliz scou/eriana(Scouler's Willow).
4. The grass on the 1.56 acre building site has been growing undisturbed for at least 40 years,
giving us a thick layer of sod.
5. Drainage naturally flows along a slight contour to the west towards the stream bordering the
property. There is also a natural drainage channel from the eastern side of the property just north
of the building site running to the west side of the property into the stream. See Marsh&Meadow
short plat for drainage channel.
6. No excess noise will be generated by the use of the property other than minor excavation
during the sand filter and manufactured home installation.
7. There are no significant features or critical areas within the 1.56 acre building site. Beyond the
75 feet wetland buffer, the property includes wetland, a susceptible aquifer recharge area, a
frequently flooded area, and a type 3 stream bordering western side of the property as recorded
in the Marsh &Meadow short plat.
8. Property is bordered on the northern edge by Embody county road. To the western and
southern side of the property are lots 4 and 2 of the Marsh & Meadows short plat, which are
currently vacant, both including critical areas as recorded in the Marsh&Meadow short plat. The
eastern side of the property is a residence with a pond. Pond is over 100'from the 1.56 acre
building site.
9-21. Permanent Stormwater Control Plan
9. Drainage will be routed to flow northwest from the house and disperse toward the natural
drainage channel as designated in the Marsh&Meadow short plat.
10. Not applicable for the size of this project.
11. Goal is to disperse drainage away from environmentally sensitive areas and toward existing
natural drainage channel.
,
12. Natural gravity flow will disperse any water from impervious surfaces town tdsf n atural t1
drainage channel as delineated in the Marsh&Meadows short plat. r" ` ; f
13. Not applicable. :
.._ i
14. Not applicable. i
[r)rPTorJ :"C„. ,,
15. No fill will be required for this project, other than the washed sand and rock for the sand filter
system and small amounts of pea gravel in the foundation area and dispersion trench.
16. Not applicable, as we will not be using fill or soil brought in from an outside source.
a
17. No surfacing material will be used other than gravel on driveway area. t —
18. Very minor restoration will be required as we will not be removing any trees or deciduous
native vegetation. If any area is disturbed, native vegetation will be used to restore any disturbed
area.
19. Not applicable. Cr= y
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20. Conservation easement AF#432689 used to determine the types and methods of vegetation
restoration for critical areas, particularly along the stream bordering the west side of the property. 66,+
(Does not affect 1.56 acre building site area)
21. No permits other than septic permit SEP00-00246 which lists all conditions of installation in
detail.
Section I—Construction SWPPP Narrative
1. Construction Stormwater Pollution plan Elements
1. As we will not be removing any vegetation other than grass, clearing limits will only apply to the
areas being used for septic system and foundation pit.
2. Access has been defined in the form of one driveway leading directly from the access
easement located on the eastern edge of the property to the area that will be affected. No other
area will be used to access the site.
3. Because of heavy mulch-like grass in building site and relatively level contours, flow rates will
be naturally controlled.
4. Silt fencing will be installed bordering areas being disturbed to control potential sediment
erosion.
5. The grass on the property has been growing undisturbed for at least 40 years, giving us a thick
layer of sod which should provide adequate soil control during the construction process.
6. The 1.56 acre building site is relatively level. See site map.
7. There are no drain inlets or existing storm-water collection systems anywhere near the site.
8. Due to the level nature of the building site and natural wide dispersion of runoff, and dry
season installation, no temporary channels or outlets are planned during construction.
I
9. Pollution will be kept to an absolute minimum and any pollution causing materials that can be °
used off site will be. Following best management practices, concrete cleanup will be kept to the
foundation footprint where the concrete will be poured.
10. If de-watering is required, it will be directed and dispersed towards existing drainage channel. •
11. In maintaining the best management practices, storm-water will be appropriately routed end
any temporary controls will be appropriately maintained and will be removed immediately
following completion of the project.
12. All stages of the process will be phased to prevent abundant storm-water runoff or erosion
problems, and all excavation will be finished by the end of dry season. All contractors are v
currently scheduled to ensure a smooth transition from phase to phase in this project. M o
2.Adjacent Areas M
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a. As the building site is 1.56 acres and consists mainly of grass on level elevation, no adjacent *' p c
areas will be affected by site disturbance.
b. The drainage channel is a 30'wide grassy swale running east to west across the entire 8.8359 C ciJ
acre property shown on map. pCC
1.64
3. Environmentally Sensitive Areas �`yu
a. Property includes wetlands and a type 3 stream bordering the western side of the property as
recorded in the Marsh& Meadow short plat. There are no environmentally sensitive areas inside
or closely surrounding the 1.56 acre building site.
b. Not applicable, as there are no environmentally sensitive areas on the 1.56 acre building site.
4. Erosion Problem Areas
We do not anticipate any erosion problems since we will not be clearing any vegetation that
would cause such a problem. Also, as the building site is level, erosion would be extremely
minimal.
5. Construction Phasing
a. Septic system will be installed first, the foundation will be poured second, and the placement
and installation of manufactured home will be third.
b. Project will be completed in one phase.
6.Construction Schedule
I. Septic system and project-related excavation to be completed by end of September. Placement
of manufactured home will immediately follow.
II. a. Any construction done during wet season will be interior finish work.
b. No construction will affect environmentally sensitive areas or be done during wet season.
7. Financial/Ownership Responsibilities
a. I, Dominic J. Svornich am solely responsible for all finances relating to the project.
...
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b. Not applicable, as I am the owner/builder. , --. • .
8. Engineering Calculations 4 `
Not applicable.
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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.
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APPLICANT SIGNATURE
1
By signing e onstruction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to h best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owne`r`t;' ed property.
•
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(LANDOWNER R UTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
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THIS SPACE Y BE USED FOR ADDITIONAL NOTES, IF NEEDED:
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DEPT.OF COMMUNITY L)EV'LLOPMENT
12
stormwater site plan template—rev.10/1/2003
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