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HomeMy WebLinkAboutBLD2004-00559 • 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#: BLD04-00559 Received Date: 9/3/2004 SITE ADDRESS: 60 HEMLOCK ST Issue Date: 10/25/2004 PORT TOWNSEND, 98368 APPLICANT: GERALD C SWANSON TERESA A SWANSON PO BOX 1644 LYNNWOOD WA 98046 SUBDIVISION: CAPE GEORGE VILLAGE DIV 3 Block: Lot: 56 PARCEL#: 940500055 Section: 13 Township: 30 N Range: 02 W CONTRACTOR/ DEALER INSTALLER: C &J EXCAVATING CJEXCI*099PC Expires: 8/15/200E PO BOX 430 CARLSBORG WA 98324 PROJECT DESCRIPTION: NEW MANUFACTURED HOME MAKE: MODULINE YEAR: 2003 SIZE: 56 X 27 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 10/25/2005. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): Stormwater FINAL Approval: Blocking/Plumbing: Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps HEALTH DEPARTMENT AND PU IC 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 1111111111111111111111111111.111 1111. ee ML Review Type: 0526 Type:I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Department of Community Development Jefferson County Dep port Townsend, WA 98368 621 Sheridan Street BLD04-00559 Received Date: 9/312004 PERMIT #: ,ll HEMLOCK ST SITE ADDRESS: �U PORT TOWNSEND, 98368 GERALD C SWANSON PHONE: (425)771-0118 APPLICANT: TERESA A SWANSON PO BOX 1644 Lot: 56 PARCEL NUMBER: 940500055 LYNNWOOD WA 98046 Block: CAPE GEORGE VILLAGE DIV 3 Range: 02 W SUBDIVISION: Section: 13 Township: 30 N CONTRACTOR/ C &J EXCAVATING PHONE: (360) 683-7741 POR O 430 WA 98324 (36 1-3165 DEALER: poll gg Contractor's License CJEXCI*099PC Expires 8/151200 INSTALLER: C &J EXCAVATING CJEXCI*099PC 811512006 (360)683-7741 PO BOX 430 CARLSBORG WA 98324 PHONE: REPRESENTATIVE: PROJECT DESCRIPTION: NEW MFH SHORELINE: MOB MANUFACTURED HOME: SETBACK: TYPE OF WORK NEW MAKE: MODULINE TYPE OF IMP BANK HEIGHT: 68,500.00 YEAR: 56 X 2003 VALUATION SIZE: 27 LABOR &INDUSTRIES APPROVAL? SEWAGE DISPOSAL: ALT CAPE GEO PARCEL TAGS: _NO YES---NO WATER SYSTEM: STORMWATER: BEDS BATHROOMS: Plat Conditions Exist: AREAS Erosion Exist: Prop: 2 We smictland Streams Prop: 2 Total: 2 Seismic Floodplain Total: 2 Flood W ay Landslidr e Shoreline .,.; Routing Date: G ,r� _ _ ._.._ - _I •i•i•HIV W 1r Apr. -. Vte Amount Paid By: Date: Receipt: OCT 2 5 ZOOM Type $154.00 KAS 09/03/04 67605 Manufactured Homes $52.00 KAS 09103104 67605 Jefferson County Planning Application &Building Department Potable Water al: $2Q6.00 , OW + Total: :i. a, • , ' $ V 1 JEF RSON COUNTY ASSESSOR JACK WESTERM III ', -} ( r - F RSON COUNTY COURTHOUSE !f i ,^Lz (I PO fBOX 1220,PORT TOWNSEND WA 98368 ASSESSOR 1 (360) 385-9105 MOBILE►UUOME Ii�IFORMATION FORM AMER'S NAME / MAILING ADDRESS: ' PT Of C� ri N � OTA TAX STATEMENT AME• -einctg, C_, 4 T°�e- .`'(\- SftDCmsof. The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the DDRESS•• PO C)1— t 04-14 previous ownership and location of a mobile home. This will � � � � ��� � � help our office determine whether the mobile home is already )DES on the tax rolls in Jefferson County_or if it has been moved to this county frpm another area. Please see reverse side for ELEPHONE NO: LDS 1-- Di i% addGticeal information. ) MOBILE HOME DATA: > I (A) MAKE im o&d.l IA e. (B) MODEL ( livt( 0 (C) YEAR 9,00 3 (D) LENGTH 516 (E) WIDTH an 1 (F)SERIAL NUMBER a0-O&S (G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) 4 to J '56 0 (H) PURCHASE DATE Qj r4 1 61 2) PREVIOUS OWNER / LOCATION OF MOBILE HOME: (A) FROM WHOM DID YOU PURCHASE MOBILE Got/en Vk ookeS -Ln c_t -� �C.) q ,.� ADDRESS •1( l51 Qk IV) W 6I beVQto'\� A, 9 (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES 0C), (IF NO,WHAT COUNTY? Cket It tk1M ) IF YES,WHAT WAS PREVIOUS ADDRESS OF MOBILE? 3) WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES (B) IF LOCATED IN A MOBILE HOME PARK: NAME&ADDRESS OF PARK SPACE NO. (C) IF NOT LOCATED IN A MOBILE HOME PARK:NAME OF LAND OWNER: GeprA& C. i Te-Pe5cL' S v SO LOCATION(ADDRESS) 1\ 0 clop Aef` l Cot (,,Vei" l fkrs('t;C&. 1 0c I1Ent ocl r,,'be A4I > REAL PROPERTY PARCEL NUMBER/DESCRIPTION 9 4/0 - 50C (9g5 lets kickitl e k 0t��� �, Ne Leo s CoVon (A,,,t10 THANK YOU FOR YOUR HELP! - lL)--(A 5,''n SIGNATURE C4t)dk: KELLI LARSON, roperty Technician THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION. • • .,. ,,:,,,,, .: , . 1.. N °o 1013i1111IIII111 3 � 0 Ocp � N( C° ,= z � � w — � Ok �C1 oo o i". 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After an initial Geographic Information Systems mapping review, the following ESAs were confirmed to be present on the subject property: Susceptable Aquifer Recharge Area (SUSC), Coastal Seawater Instrusion Protection Zone. 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.) 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. 5.) 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. 6.) 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. 7.) Critical Aquifer Recharge Areas may require special protection measures to 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. 8.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:• Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. 9.) 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. 10.) The applicant is proposing to create or add 2,352 square feet of impervious surface and 3,598 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. 11.) A Medium Stormwater Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 12.) The project shall adhere to the Best Management Practices (BMPs)to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 13.) 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). 14.) The site plan as submitted with the manufactured home installation permit application on October 21, 2004 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 22, 2004 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 15.) 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. 16.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. • 17.) 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). 18.) 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. 19.) The building height is not to exceed 35 feet. 20.) The setback from the property line adjacent to Hemlock Dr. is not less than 20 feet. The setback from the property line adjacent to Dennis Blvd. is not less than 20 feet. The side and rear setback from the property line is not less than 5 feet. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply. 21.) Exterior lighting for residential uses shall not exceed twenty feet(20') in height from the finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. 22.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. 23.) This parcel is a legal non-conforming parcel designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 24.) This parcel is served by a public water system (Cape George). 25.) A septic permit (SEP02-00109)was approved May 30, 2002 for a capacity of 240 gallons per day. 26.) Hemlock Dr. (P71) is a private road. An address of 60 Hemlock St. has been assigned to the parcel. 27.) A minimum of two (2)on-site parking spaces are required for the single family residence. 28.) This parcel was created through Cape George Village Div. 3 under AFN 180841, recorded August 27, 1964, Volume 4, pages 59 -60 in with the Jefferson County Auditor's office. PERMIT 7 DLU . U - 04 ' 0 55 1 15 i _ , i AA, rtlific>, v.. ON N11 DCD � - I, JEFFERSOIV19w ' DEPARTMENT OF COMMUNITY DEVELOPMENT ;it 2 621 Sheridan Street • Port Townsend • Washington 98368 --- A,O/ 360/379-4450 • 360/379-4451 Fax =PT. OF c3u, , u t , s✓tvE.OPM;i'• : `�'BxNG` http://www.co.Jefferson.wa.us/commdevelopment/ --- STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# 6 4-1 - !-; (. c— PROJECT/APPLICANT NAME: /r, o (tt i C 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. i / I—I\`�tc:t( ,ry;� -Kict51R)& 1-e e rib w ,ci., Cc4 ti beo/--te. of 1i ev\c, J t Existing Conditions Summary 2. Describe the existing topography..Indicate contours on the site map. � J Ft& - lc e s Ii \LI li3Vc S fittli\ -`�1:, L 0,r, 1. x 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. 4. Describe the existing soils. Indicate soil type on the site map. . st is it �.X Ci ci S C.i C 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. c 1.1i Ck_ ,k &Pa-i),. n c\rt e :-. Le t/v(0a = Li,At S 44; -�-rear,,s'+etiv - �t•.p, t,l,C. ,,,' b 6. Describe any excess levels of noise generated by the propo ed Ie or a� Lr a4Q t APPROVED �� t , STORMWATER PLAN -," ,•----"" OCT 2 2 2004 stormwater site plan template1/2o43 5 JEFFERSO O NTY F12: OF COM I- miv1:LOPMFNT NATIJRF.: 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. thegeneral vicinityof the site,including land uses and structures, utilities, roads,and sensitive/critical areas 8. Describe adjacent (streams,wetlands,lakes,steep slopes,etc.). tf � (.7 .f. '_ i _l_ iZPC'. :5-.1 t_c tr.Z-C,e, , I C;I'C2`) t �'; , I\11'?,' k 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 within the site. Locat these facilities on the site plan and differentiate proposed facilities from existing facilities. `i tv l/i'� t)e cer �: L I( LE �t 4�i!s �.� N<4� �1��'� . 11�,, �p�..`��, 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 �~~� r ,!a`! �;""r • 12. Describe the flow control system. im:PT 01=cU,,:., \ ,•l V> _prr 6 stormwater site plan template—rev.10/1/2003 " 1 t 4 n ^r L fr.. 13. Describe the water quality system. Ut I f, Pc PERMIT # 0 4 - 0 5 5 jE FFERSON COIIMY ODD L.PT Oi ;, �t f: 14. Describe the conveyance system analysis and design. Af � 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. 17. Describe the s��� proposed surfacing material. ;a,t)ek t /- 18. Describe methods for restoration of the site. t ci j _ !fig-� �:��" f�a` NS' e"�.� IJ`�'ot<�,'���a�l�Yi 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. 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. 21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or restrictions here. • stormwater site plan template—rev.10/1/20033 7 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 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. A_c L._L'.l't.` - f.�� .\V T 1R'-1P '1,,...,Cti''d�� 2. Establish construction Access. .-`) I As:Ak `- =`Y"Y"l b id i if t 3. Control Flow Rates. 4. Install .Sediment Controls. �,,1 a `µ' 5. Stabilize Soils. 6. Protect Slopes. r- 7. Protect Drain Inlets. � ,Aihrt 8 stormwater site plan template—rev.10✓1/2003 PERMIT # BID -__. _. 12 Required Elements—Construction SWPPP(continued (� ! '_i) 1. t t u a y 8. Stabilize Channels and Outlets. 0 4 — 0 5 `� f(''''r � JEfFEBSDN eon ► C[T 9. Control Pollutants. " r - `_.,...J,,,ItortX, Z=<v ,z,,, � ,�.i ��t1 r� VN� i.,d',- A, '.,. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). tv1k 11. Maintain Best Management Practices(BMPs).{� e r _`�r`61', ?k-C i=A. ,"e,-,A±,tom S 1 12. Manage the Project. r3 pm 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). r-, 15e ,1,rike.`ik �,:•)ti 99 Lc 112 (1FZ> &i6 ii3('.p,'V ` ' tt:,c7,7&---2,->-------,) ( ,, b. Description of the downstream drainage path leading from the site t the receiving bock of water inimyrj distance` f 400 yards). O t z l►'��0 A 1 ,R.Api,...., i a' c 3 t. ytil < \ cr i,' 3. Environmentally Sensitive Areas. .(40)s et Ao c- 91."`j 'OR. ._ a. Description of environmentally sensitive areas that are'd'n or adjacent to the site. ,,- storrewater site plan template—rev.10/1/2003 9 • b. Description of special requirements for working in or near environmentally sensitive areas. 1 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,�rodibility,settleability,permeability,depth,texture,soil structure). ,1,y4'�_} 5. Construction Phasing. a. `Construction sequence 'so !f 9 /1 '/ y \^ :,,/k (A /K.if ! 1 'ZC- a't)t- 11 +�Y�/�,�.�{� I tit -,L,, A., 4P V:;�(. k.i' f ':.R2 l t.i t... rJ .-) b. Const ion phasing(if proposed) i;‘,-,''' p1/4 7t 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide. proposed construction schedule. i1 II. Wet Season Construction Activities. r a. Proposed wet season construction activities. b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible 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. t 8. Engineering Calculations. Provide Design l Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. i��1 b. Diversions. N) c. Waterways. /�f t 1 d. Runoff/Stormwater Detention Calculations VI\- I x_ 10 stormwater site plan template—rev.10/1/2003 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 best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. jec ,,,) '.-- t',.--(Q ( -%. V,.; .4-v"' 'i V Cti C g- (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DAT ) I THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: FD)4----'-- ---1- ---------T \I r. , \ I L . 1 ; ti L. �;. _, .trlelY PT.OfCLis r tu� 4! tVELOPt _ stormwater site plan template—rev.10/12003 12 n IIMINENMEMIN OWNER BUILDER STATEMENT • The signer of this statement does hereby certify that'Jiey are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: C `� J `v�iFi�r ( .�i ) 6L'3 - .?ill (JCv ) l - . /(c6 MAILING ADDRESS: 'pc. . (.3 f-, c ( k. c- f EMAIL: , CO CONTRACTOR'S LICENSE `i (� WAINS �7 NUMBER: J C_X C I -X— 0 ?? pc_ NUMBER ,I N 7 ARCHITECT/ENGINEER: / PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: X New ❑ Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: - - Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: 2., Height: `, 'Individual System ❑ Repair ❑ Masonry SEP Permit# 6 2 -CSC_,1 C ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 2 ❑ Public Total: 9, Name of System: If this is a Commercial Protect you must answer the following: Number of Parking Spaces: Current Proposed: Number of ADA Parking Spaces: Number of occupants(indudes 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: 0 Underground Tank ❑ Above ground Tank Size of Propane Tank: i i Heat Stove 0 Cook Stove Cl Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / 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 For Office Use Only Current Proposed Amount Main Floor Consistency Review: 2Nu Floor Base fee: 3n0 Floor Additional Cectlori • ' � Mezzanine: Plan Check!ee: LSEP ?`3 ' Heated Basement State Surd arge'fee: t Unheated Basement Pot WaterReyi�Vy fee: r r LLPt Qr !r`J,, � ii LtVEitli` ?� QD .'. Other Unheated 911/Rd Lj Approach fee: Garage/Carport TOTAL $ '41 Decks ;� 1 ? 1 C Receipt Number: /_ 7 62,0 5 Other Cash/Check Number: �2(,F ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish /3/ Initials: I G:\PeimitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc — �..�.la0N---c o�� JEFFERSON touN- L _.� i..._ .__r ' A DEPARTMENT OF COMMU DEVELOI N' —W ; ` `� 621 Sheridan Street • Por! iwnsend •Was in ton 98360 ; ; 360/379-4450 • 360/379-4451 Fax S E P — '^' ' i' ,/ �qs Nc www.co.jefferson.wa.us/commc evelopment Master Permit Application DEPT. OF COifr'"i hi;'� uE1rEl Oi't:3E[--..1- : Project Description(include separate sheets as necessary): Mei il a 41, 3k e pLacQ on LA-% )bI v�3, ��t t la e.1 C61 C�- Tax Parcel ,I ` �-`1�--�-� Property Number: C1` '©-�� C U Size:.. [A) ry�;,�j I (acres/ quare fee Site Address and/or Directions to Property: j/l� (Fne' v i,,,„, vttf,'s tiny, 1-1€4, �,,1<_ z'1 ry , it, Property Owner(s)of Record: Gel,(1 Teresa A Lo yiS v.'t Telephone: ;,15_`j 71-O, i Fax: LOS-77 1- 011 8 email:ctC xtrisix}),1 cottacSt,AHf Mailing Address: () 8 r.)c �y i l�c:(i3/M,O r„^tQ 1 ill 92 C7--t 0 J Applicant/Agent(if different from owner): J1 Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) Building ❑Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]*" [7 Single Family ❑ Discretionary"D"or Unnamed Use Classification 0 Garage Attached/Detached 0 Special Use(Essential Public Facilities)** )(Manufactured Home ❑ Boundary Line Adjustment 0 Modular ❑ Short Plat** 0 Commercial* ❑ Binding Site Plan** 0 Change of Use ❑ Long Plat** 0 Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane 0 Plat Vacation/Alteration** 0 Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment 0 Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference **Requires a Pre-Application Conference Please identify anyother local, state or federal permits required for this proposal, if known: <<�pE: EC.E C on�� Ci -B;-t11_SC 1iL fR' , i, DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent 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 resets,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 provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business ::iure: / , p4 Cl A.Z. -0u Y1 Date: 'te/ 2C7 4 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 issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfers e responsibility adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: -(.,J Q ( {r 1.�1-.e\ Date: a jiri 0004 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc rw. z9S 9 YM •S i ,,i+t 1.240d.o a Pt X08 0d U4S " S . �. , ` �1 S1 sso—oa9—Ob6 # 130dbd X b l r s C\ '3N1 'eNt 3NIDN3 ONl 31.. 11.00S NH0` SNV1d N31SAS ? 3LVM3iSVM "AT 7 :� - y OCT 2 1 2004\ �� i W co r-a cv JEFFERSON COUNTY " :' :_j O i.- N z z a z DEPT. OF COMMUNITY DEVELOPMENT G . 1 �/ d N y a - „4 W m � i TM'r' Fiery ., U 1 mET._ w ril ,n 1 I "'� a �'�" --.0 tti it a 0. �' 'may _ = " A LL r Ii IR O +-1 ' N ti III /04 U E PERT PIPE o --- esciniYlf r gtiNQ (IA1�1% 00.04 i to1-1767:'----4,1, � i f . •i' c • k 2 I X . .i. a ,...i 0 li h _ f • d, 1 4� I o ,--i \ g I 1 1 ,0 Si.\.....„\\\7\7\\a\i. Pcsi t N g iNA,. a.ce4 . ; WI 5 i . . L.I: . q ,,,i . \ L\.._ \...'.. 9 0 4. t R g II Q. , '.„z7 c, '4,77 ., 1 �, T4" . 1 ....\ ..,...\ :// , . _ *itt -, ,d., i.r.. 11 C 0 Atxi iy� P' 2 GM tin N rsMINTrr . _ 1 r, iF ! . ' * [ r5'1. a _ �a &CP . ... i 9-e• I / w t' � 1. R CS' MOO I p 1 ,i ,' ,S �►•• `�A,.s1 t'J ri to j s, . i s 8 r•XS Nvye a ���� cj Q r,4-1 1.1 4 61 f Lit 0 r�Lo 0- ` ` � �CGt" i g i g • ' /''' .� 5. . / j 8 §6 e i. ? id! p -ii-- ] E c E. tiv E 0 i • . 4Qi,ece4 t . . I OCT 2 1 2004 eS/'cPe,i c t JEFFERSON COUNTY DEPT. OF COMMUNITY DEVELOPMENT 4