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HomeMy WebLinkAboutBLD2004-00608 a MLA04-00567 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00608 Received Date: 9/27/2004 SITE ADDRESS: 234 PORT HADLOCK HEIGHTS RD PORT HADLOCK, 98339 APPLICANT: BRODERS INC PHONE: (360)797-7722 4503 OLD GARDINER RD PORT TOWNSEND WA 98368 SUBDIVISION: PORT HADLOCK HEIGHTS MH PARK Block: Lot: PARCEL NUMBER: 989500001 Section: 11 Township: 29 N Range: 01 W CONTRACTOR/ DETRAY'S LLC PHONE: (360)491-9500 DEALER: GARY DETRAY 3650 PACIFIC AVE SE STE A OLYMPIA WA 98501 Contractor's License DETRAL*973BT Expires 1/30/2005 INSTALLER: DETRAY'S LLC DETRAL*973BT 1/30/2005 (360)491-9500 GARY DETRAY OLYMPIA WA 98501 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION: NEW MFH (LOT 11) TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: KARSTEN SETBACK: VALUATION 74,900.00 YEAR: 2004 LABOR& INDUSTRIES APPROVAL? SIZE: 66 X27 BANK HEIGHT: SEWAGE DISPOSAL: CMY WATER SYSTEM: PUD 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: VF&W Landslide � �L fCA) Shoreline Aquifer Type Amount Paid By: Date: Receipt: Manufactured Homes $154.00 KAS 09/27/04 67760 Potable Water Application $52.00 KAS 09/27/04 67760 NOV 2 2 2004 Total: $206.00 Jefferson Comity Planning & 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#: BLD04-00608 Received Date: 9/27/2004 SITE ADDRESS: 234 PORT HADLOCK HEIGHTS RD Issue Date: 11/22/2004 PORT HADLOCK, 98339 APPLICANT: BRODERS INC 4503 OLD GARDINER RD PORT TOWNSEND WA 98368 SUBDIVISION: PORT HADLOCK HEIGHTS MH PARK Block: Lot: PARCEL#: 989500001 Section: 11 Township: 29 N Range: 01 W CONTRACTOR/ DEALER INSTALLER: DETRAY'S LLC DETRAL*973BT Expires: 1/30/2005 GARY DETRAY OLYMPIA WA 98501 PROJECT DESCRIPTION: NEW MFH (LOT 11) MAKE: KARSTEN YEAR: 2004 SIZE: 66 X27 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 11/22/2005. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Fgoting INU 0� - FOOTING, SLAB or PADS USED): _ /I'�Ac SYsrtM d / 7 a "I' lJ/GGird,t/&frm Stormwater FINAL Approval: • Blocking/Plumbing, I -2j) -pz,- v Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: 7K r- z. -CI rfz.I iVz/061794 HEALTH DEPARTMENT AND PUBLIC 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 # 1.) The application was reviewed by the Jefferson County Department of Community Development staff on October 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 and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: Special Aquifer Recharge Protection Areas. 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.) 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. 4.) 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. 5.) The applicant is proposing to create or add 2724 square feet of impervious surface and 4000 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires that your proposal submit a stormwater plan meeting Minimum Requirements#1 through #5 of the Stormwater Management Manual for Western Washington. 6.) 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). 7.) The site plan as submitted with the building permit application on September 27, 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 1, 2004 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 8.) 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. 9.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 10.) 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). 11.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 12.) The building height is not to exceed 35 feet. 13.) Minimum setbcak from Port Hadlock Heights Rd right-of-way is 20 ft. Minimum side and rear setbcaks are 5 ft. 14.) This parcel has been designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 15.) Community Drainfield "B" (•95-00291)serves this site and was finale�anuary 4, 2002. A septic permit(SEP04-00246)was approved on October 20, 2004 for a septic tank and pump chamber to be connected to Community Drainfield "B". 16.) Port Hadlock Heights Rd (P516) is a private road. The road approach is existing and an address of 234 Port Hadlock Heights Rd has been assigned to Lot 11. 17.) Jefferson County PUD provides potable water to this site. 18.) This parcel was created through the Port Hadlock Heights Mobile Home Park Binding Site Plan, filed of record April 15, 1998 under AFN 409746 in Vol 1, page 28-32 with the Jefferson County Auditor's office. The binding site plan was reviewed by Jefferson County Department of Community Development under BSP94-00001. 19.) A minimum of two (2)on-site parking spaces are required for the manufactured home. 20.) A stormwater plan for a medium project 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. .._......._,, IDE TFUNY'S , ,.......k.o., 11 ...10064° .,,- T•l'ir."‘'- ',,,e...°-*'. ----"T- ,\'\,, Manufactured Homes . Sates & Service --e-- --,-,", www.detrays. com 9 „ k,li ‘Arsi‘i ‘ -J . '''' SI tivAilsoot5t.* - pior suo, cik toiso "tige spa.$7 ci4t 1, 2004 . mop 0 , ,, , 4 ',,•:'' .; l't .., 44 i r ; ' ' • ,--- . .. :400,1,11,11,104- j ! i .e . i , . . .-4,by i ,.., / 1742 SQUARE FEET • 3 BEDROOM • 2 BATH I IOPTION.TA&AVAILACLE ,,,otTie visit our display at 3801 Pacific Ave,. SE ' a ' "t I Inisri • .(01 !r Family ROOM ' CAT411 R00411 I ZIP. ....-1 Lail Ent ris Olympia, WA tc` i! 200' II 4' MUNI 111.4.41 -r— 41' I ' 711111 NI irraraai , ,I /11111111110111111111119 Or give us a call at: , , , faxiiiiig 800-982-1115 ;:,..,r MIN‘4 / ./ .., 360-459-1500 nr, la' A V Nklrocrn 2 eadvon,?, II ,rInq gOofr / McsterieE,oldrOOPI , 4 101, V 226' ' r 1111, 1 •. St1111' •-_-_---,--_,..,— ..----- to E TRAVIS ,------------ --, Wittp./..14_,WItAi H(111 ..4.....bOrel. , •. .ff. WWW.d•trOVI Ct-t11 * UP TO$500 VALUE•GOOD THRU MAY 2004 . 7 (?.) ii 7, zi,. r APPROVED SITE PLAN OCT - 1 2004 Sri' 2 7 2004 JEFFERSON COUNTY DEPT.OF �OJ MUNiT � O SIGNATURE:DEPF �(Y�p d- U, . Rtlit.�`.1 -'' s E� h t ,r co 44 .;), cep iv �� .'8.fr v .2 k Ss� ` 4)b �o NX��' lam, pS'/4,4, 4 ' 5a/ 411.,..46. 11 P oR,i_ N NOLO cK N 1c- -TS AAA 0 14 Lo T 1 1 6 J 6a r f+2) 4 S63 Call Gai-dine. 62 d, VRopERs 1�cC. 4 �,�, gg.� / VT 5'°° ®of (e, v1" codes JEFFERS • OUNTY DEPARTMEN F COMMUNITY DEVELOPMENT 14464,1 `4 621 Stmeridair»Street nd •Washington 98368 , G " `� 0 ! Ein',� 9-4450 • 360/379-4451 Fax i1�-•� { !,� �� �,t0 www.co jefferson.wa.us/commdevelopment J ii. SEP 2 7 2004 ` ' Master Permit Application , Project Description(include separate sheets as necessary): MFG. l-}o ME —INSTALL AT1E Tax Parcel Property Number. ct6 9 S o o 0 o Size: I g,1 6 O 1 f Z (acres/square feet) Site Address and/or Directions to Property: 2 3 i/ f�o r 4- (--i t d /o c t j t e,;4/s y 'o ccl Property Owner(s)of Record: $R b fl€R$, l N G Telephone: 3 60 -.R-7 7 7 22_,.- Fax: email: Mailing Address: -1503 O t d G 4►.d i n r v 1Q d• jO r ---r;:)w.4Jc t L lama 4 1 FS 3 C g Applicant/Agent(if different from owner): P A b... V E NN&M A N Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) 0 Building ❑Variance(Minor,Major or Reasonable Economic Use) ❑Demolition Permit ❑Conditional Use[C(a),C(d),or Cj** ❑Single Family ❑Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached El Special Use(Essential Public Facilities)** ,Manufactured Home ❑Boundary Line Adjustment ❑Modular ❑Short Plat** ❑Commercial* ❑Binding Site Plan** ❑Change of Use ❑Long Plat** ❑Address ❑Road Approach ❑Planned Rural Residential Development(PRRDyAmendments** ❑Propane ❑Plat Vacation/Alteration** ❑Allowed`Yes'Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management 0 Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment o Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment ❑Forest Practices Act/Release of Six-Year Moratorium *May require*Pre—Application Conference **Requires a Re-r4pplicatfon Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: Za 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 may result in thisknowledge. Any material falsehood or any omission of a material fad made by the owner/agent with respect to this application packet permit being null and void. I further agree to save.indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorneys 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 y required later inspections.Access and right of entry to ' property shall be hours. requested and shall occur only during regular business Signature: t01/...,..,,o, „-- -t .,� CJ Date:filar 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 lake"of an endangered species as those terms are defined in the federal law known as the 'Endangered Species Ad"or"ESA.`Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this haspermit been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your ven if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he.she or it holds individual and non- erablef esponsibility for t SA. The Applicant has read this disclaimer and signs and dates it below. Signature: ,n�C Date: Vz.p/oet - t G:\Penn;tkentcr\FORMS\DRD FORMS\Master Pemut Application 7-8-04.doc OWNER BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein.that they are not licensed contractors and that theywiltbeasstanieglhe-naspoostbelyttlhe-Senerat Contractor�� project. :, i, Signature: L y 4 Date: `t.� � f' • p ' 1 GENERAL CONTRACTOR ORt1AANuFACruRED HOME INSTi�LLE PHONE: f , ?4 C a T�� De -Irr41 ( ) MAILING ADDRESS: EMAIL: `_L, _ , CONTRACTOR'S LICENSE WAINS , NUMBER: NUMBER 0 d 7 ARCHiTECT/ENG1NEER: PHONE ( ) FAX( ) MAILING ADDRESS: Ems. Project-Type: - : fame Type: ; Bathrooms: - . - - ... -. S Iine: Ty pe of Sewage Disposal: O NAddrtion ❑ Steel Existing: ❑ Sewer Proposed: Bank Community System ❑ Alteration/Remodel ❑ Concrete eete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry Bedrooms: SEP Permit# Q --Ai ❑ Demolition CI Other Water Supply Existing: Setback: ❑ Private well ❑ Two Party Type of Heat Proposed: _ Pubic Total: 3 ame of fl„n 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(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 ❑ Above ground Tank Size of Propane Tank: ❑ Heat Stove 0 Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove 0 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 including the reserve area. S uare Foots a i �'` R � 1 ` :;. Y-:'a CUrrent Proposed LS. ,Y` sk yq -`�-`a :.�•—' �t -:"T`_^d 3. � �``5�' , Main Floor "< >� `,,r1 �-441.4f... `7` ,�- . a•' _`��`, 2 Floor tz '' _--.. -r -}ice .1 S 'i 'Se ,S a a °i; , :AO?, y.,,,.�- .1.t.. , `'•- s"�3'; , ,,, Rya• •2 ^ . 3t0 Floor M 3 . ��. ._ > 1-, o� , .''.n ..„--,`.�.` .. "�� ` ' *gam' ° +'-''" ` •' :rT,eslx'r. ""•,J ' ,,yr ... .s , m ti�,, + -� • c .. r 9 ? - 'Mezzanine: `, 41- e- 4... , 1,3 .. w.:1? \ ' ••• q y3_ ' } Heated Basement t ' 1 Cw ^Y�t .1 y �, � ` 7� st _ P"xEA* l e Z '�� �..ti tin"yM-. �1.3-,p`-y.4.jt 72"..Y Y t..�� "-.. . •+f` � _ Unheated Basement ti s`-. �:.-. w. .� �� s Other Unheated x�� -t t , Z'r.ri y..i - - '.,1sT Garage/Carport ' 4 ..I.y� i Yam_- �..r. y' e w+ -14' d 3>e ` Y cam.•. N- t s..4": ai r l r.t t, eaa r F 1� � '.'+' .-. % r o- "1� :r ✓ DeCkS _, x < ,. ,^ i'r! e ,, 1 f ,r 1� t #� ' 1� • < +1- Ta ,r,.f. y •R'f 4. f Ysg 7- i "` b�ti' �r S�F'�"• }, y:R 4L 1't ESTIMATED COST(REQUIRED) r x -"..:".5s t. , a� a t Cb aG .,"4 e '.r4tt .Farr market value of all labor and materials foundation to finish r*,A -` r � ' r n 5on ,4 - ,� r�'l r t s• .cis. '*40.... R!,`i�i..Q�'�ss # e , t i .K �yy,, ".q.sap. r a .-il f,+ -rA4.4,. :fi. . -•_:,-;_.S�.Je` ' ?It To.` .,:5�'.f_�,4 •`..x`.�1/41.-}.- 4-k-: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-5-04.doc • • ,..`� 64, JEFFERSON COUNTY 1 �t t ,�� t tt II 4 DEPARTMENT OF COMMUNITY DEVELOPMENT ;i' I , 621 Sheridan Street • Port Townsend •Washington 98368 SE �� M G2° 360/379-4450 . 360/379-4451 Fax http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE l,af // I MLA# PROJECT/APPLICANT NAME: a RODE RS C—N N EJv MAN I 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. M 4 rl v f•c-4 r..red n LA,141j 1-4,fcl die.vet.v44 e[o d S e // er r Q4j'Q ft.'t-/- I Q it See i n Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the siteit map. Fitt e h S C cc -Fi o 41 `t/°pro Y/414 % a I' 4,,--. .e 4 , o Srn4 t/ ( SO X 20 Grpres3,or1 hccr r,dad_ 0 2.044 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. C [cd,.d «rs 47.Somme a�� i )/3 0 w/ 4-1 _-t-/SS c-,../i /7 /! So,*nr 7�-')-tr-S rem4io,4 . 4tS I r/ Y1 4 7 ti►t! 4-�S y .7 d!7,*'7 rS4/41, < ('.) 4. Describe the existing soils. Indicate soil type on the site map. G..'e.lIV 4-0 vcr1 C,r, t„eI141 ta4ire I. -1- ' 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.Rv{ s-l:n6. bydr•nl•7V- iS -csfet4ia1lI y i hf; l 1 4Yt by, .1,e 4-. �c, oorer) etnl. Sb I Ci. 1 A -Ii0n S• 6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED None. STORMWATER PLAN OCT — 1 4 stormwater site plan template-.rev.10/1/2003 JEFFERSON COUNTY DEPT.OF COS bT E pME 5 SIGNATURE: r Y /1 • • 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. of o vl e V cZ p-�- for. J w 11,a&--o L l 1r-o a,d 8. Describe the general vicinity of the site,including adjacent land uses and structures,utilities, roads,and sensitive/critical areas (streams wetlands,lakes,steep sloLp+es,etc.). \ f AIN ;QCr+L� pY> pQnCO 40 E"1ST 15 1 har ci' C IJYVC�1 Cv1 �4 SbvY .4-1,e-cS, anc iS It Signt� 1 o Iev sPu,-e i h -1--hr ° '- •I 5.1-7..yk-s--\: vt k Oa 1--o Wcs+. e-+-lier /D �$ of " -F n r .l CC NteOPMe. Le,C o n 1 1.4 rlrr s i c/C. 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. Locatp these facilitips on the site plan and differentiate proposed facilities from existing facilities. F�ll1 ; spfs�a i rVOroS,e,1 vn.e Ahod. 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.] NI pVlt- 11. Describe the perfrmapce goals and standards a licable to the prooect. TA F; t1 1i ion alt_ s-4orev w , ater- oh 4"1:S 'bT en I`�- Co r a.cii a CeA.4- D pp A Si?1 le" 1--r, �d Sa•) 12. Describe the flow control system. ICIo11e. stormwater site plan template-rev.t U 1/2003 i • • 13. Describe the water quality system. Niaht i 14. Describe the conveyance system analysis and design. NIoAe P 2 7 2004 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. Nohe--- 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. N o n-e_ 17. Describe the proposed surf cing material. Cevsle_ LaiS j J 3/1f w11nuS 0 .1 4r , V<L...1, 18. DescribR methods for restoration of the sitte. C� n c���N v 1'vl-t S r "tom 7 kt� e 1..,ay and [44k sc.• to 1 b e �-ra cl-e 1 f In-ee 4-e ll ands y e i Se 4�d n �J h � e�1� �,-1 a ss 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. N oAt 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. N ov 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. N nhe stormwater sae plan template—rev.10/1/2003 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 2.52 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1, Mark'Clearing Limits. )/ l L / / Ay/�GC 1 q Cbn� c h c 101 6atTh 1 DCa �'n, f f• lie�-e 10✓" CJ(.-4`Oh, - 2. /Establish C1 onst ction Access. 1 l b nSTvoc ti'DY) a CC>•SS Wt II bC C>z t'S / t ng rl,-;vfw ir 3. Control Flow Rates. o �,t' be 1' h �; 17'"`Z None yef-,.�`.c4 f a. 5 ran- tf j,1—o Vele4-t-tc.J g .-etve11V f14- 1 c&r+e2. 4. Install Sediment Controls. I , /Alone Y'e g-`` re 1 • C 5"1 1� f<<c. i 01 Sam( 4 ' 4 e e# 5. Stabilize Soils.Flecq— �LI-aieIIct So ; 1 )- e "-rC S c b,1 f 2e 41'04 IS l CIo 1704 f 6. Protect Slopes. 3 /Vo � )o - 7. Protect Drain Inl ts. I I /V O t-xi h i /t ,✓1 -� S ion 8 stormwater site plan template—rev.10/1/2003 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channel and Outlets. 4/-O o h 44d-e A/D D,/71e,S 9. Control Pollutants. 2004 No /0 !l� */0e7 71s f 11 'f 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). l fn rov,c/wq "1/Gr 11. Maintain Best Management Practices(BMPs). AA a i ►vL- -k►h vk A�' �4).2 -e/ 1-c{4 4 1-e.a S �-v a.T er I S�'t o��1 r1�'t1.41't-41 on t h -et c] 12. Manage the Project. ..1* a 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads)., U a J"� m 6-Pe -tt-- a r e i s 'l� 6 e cf b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). /V0Yl>✓ 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. /V't7 n� stormwater site plan template—rev.10/1/2003 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. None — 4. Erosion Problem 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). Aion8. — b. Construction Phasing. a. Construction, .p e sequence -le ftr J_ 0v Fe,L-n L 1.4111 j)7 5 1 f 4 b".r'e i — S' ot(4 « c(,-ill �! b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule. // 99 007 aU a l�ptoyt, prtptiC S t' �+r -ovndc 4'� J lYD me /'n.5 i LJt4:..9 /V0V / Su✓�c'C c� rift,.".v, NdV 10 II. Wet Season Construction Activities. a. Proposed wet seaso construction activities. �( S h Crrj a 1pave _ b. Proposed wet season construction activities for environmentally sensitive areas. v0ht 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. /V'o n-C b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. Note 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations i 10 stormwater site plan template—rev.10/12003 • • • • • Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally If the es to DCD prior to anon• The ev submittalsto approved Stormwater Site Plan, the drawings showing any structural cral shall include substitute pages that include all proposed changes, shall I changes,and any other supporting information that explains and supportsproposed changes, regise Final Corrected Plan Submittal the reason for the change. If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural (not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan ("as-bunts source control BMF completed. These should be engineering drawings (stamped by a icensed civil engineer) that accurately representthe constructed d. project the project APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information correct to the best of my knowledge. I also certify that this application is bein g made with the full knowledge and (consent of all owners of the ffected property. (LANDOWNER OR AUTHOR( REPRESENTATIVE SIGNATURE) 1�J1� (DATE)) / 7-- THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: SEP 2 2004 stormwater site plan template—rev.1 N12003 12 j if)111 ii t.k.; i, , i \.'; It 1- JACK WESTERM I! r-- JEFFERSON COUNTY COURTHOUSE ASSESSOR PO BOX 1220,PORT TOWNSEND WA 98368 SEP 2 / MA (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME / MAILING ADDRESS: THIS IS NOT A TAX STATEMENT NAME: I ' e L�.,I air.- Yl The purpose of this questionnaire is to obtain information • � �� i ��� regarding either the current location of a mobile home or the �ADDRESS: previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already �� 1_. ri Al �� ��3�G) on the tax rolls in Jefferson County or if it has been moved to this county from another area. Please see reverse side for TELEPHONE NO: G3 - 1 u-1 1 addtional information. 1) MOBILE HOME DATA: I � ,,, 1, )�m��oo (A) MAKE C.--- 1 I \ V ef-C��CS+ _ (B) MODEL .(�`('L'✓\,_ (C) YEAR --(j03.- L (F)SERIANUMBER (D) LENGTH Lk (E) WIDTH v" L-� CAI\ (G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) I u VL,. (H) PURCHASE DATE 1 ur ' 2) PREVIOUS OWNER/ LOCATION OF MOBILE HOME: (A) FROM WHOM DID YOU PURCHASE MOBILE 1 ADDRESS I (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: (A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? NO (B) IF LOCATED IN A MOBILE HOME PARK: Z.01 1 1 /1 11 f , SRlr<!'E NO. L..1 --L. NAME at ADDRESS OF PARK r t�W 1 I ULt `p" (C) IF NOT LOCATED IN A MOBILE HOME PARK: NAME OF LAND OWNER: V LOCATION (ADDRESS) • REAL PROPERTY PARCEL NUMBER/DESCRIPTION THANK YOU FOR YOUR HELP! ,p v& Y)---- '\-2efAt-A,Iy L6 SIGNATURE J KELLI LARSON, roperty Technician THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION.