Loading...
HomeMy WebLinkAboutBLD2004-00632 0 0 MLA04-00586 Revievr Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 BLD04-00632 Received Date: 10/5/2004 PERMIT #:SITE ADDRESS: 151 HEMLOCK DR PORT TOWNSEND, 98368 RICHARD K DALEY SR PHONE: (360) 609-3147 APPLICANT: PATRICIA H DALEY PO BOX 2051 PORT TOWNSEND WA 98368 Lot: 42 SUBDIVISION: CAPE GEORGE VILLAGE DIV 3 Block: PARCEL NUMBER: 940500041 Section: 13 Township: 30 N Range: 02 W PHONE: (503) 743-3295 CONTRACTOR/ JASON HAMLISANTIAM N DEALER: PO BOX 1339 AUMSVILLE OR 97325 6143 3394 Contractor's License SANTIH*063L3 Expires 6/� INSTALLER: SANTIAM HOMES SANTIH*063L3 6/6/2006 (503) 743-3295 JASON HAMLIN AUMSVILLE OR 97325 PHONE: REPRESENTATIVE: PROJECT DESCRIPTION: NEW MFH .,.s 120 4,4A.� 4- "v-3," TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: KARSTEN HM SETBACK: VALUATION 118,000.00 YEAR: 2004 BANK HEIGHT: SIZE: 60 X 40 LABOR & INDUSTRIES APPROVAL? SEWAGE DISPOSAL: ALT WATER SYSTEM: CAPE GEO PARCEL TAGS: YES---_NO _____ _____ BEDROOMS: BATHROOMS: STORMWATER: YES_—_— NO------ Exist: Exist: AREA Plat Conditions-_ p Pro 2 Prop: 2 Wetland___--— Erosion—_ - Total: 2 Total: 2 Seismic Streams Flood Way__________Floodplain ___— F&W _Landslide Routing Date: o / r�/1Cher Shoreline _—Aquifer -- c0 (J�7' Type �/ p roved/Date Amount Paid By: Date: Receipt: (6j R®` 0 ��; Manufactured Homes $154.00 KAS 10/05/04 67744 A�'" Add. Manufactured Home $32.00 KAS 10/05/04 67744 JAN - 7 2005 Potable Water Application $52.00 KAS 10/05/04 67744 Jefferson County I'fR+T ;i Total: $238.00 fl & Buildin Depart m 1 CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 B D -PERMIT#: ..� L 04 00632 SITE ADDRESS: 151 HEMLOCK DR Issue Date: 01/7/2005 PORT TOWNSEND, 98368 Final Date: 11/7/2005 APPLICANT: RICHARD K DALEY SR PHONE: (360)609-3147 PATRICIA H DALEY PO BOX 2051 PORT TOWNSEND WA 98368 SUBDIVISION: CAPE GEORGE VILLAGE DIV 3 Block: Lot: 42 PARCEL NUMBER: 940500041 Section: 13 Township: 30 N Range: 02 W PROJECT DESCRIPTION: NEW MFH / Champion Silvercrest Model 4703L THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 11/7/2005 Building Official Signature u Date I-22/6 C) 1:1F_BLD_Occupancy.rpt 10/29/19c 1110 • 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#: BLD04-00632 Received Date: 10/5/2004 SITE ADDRESS: 151 HEMLOCK DR Issue Date: 1/7/2005 PORT TOWNSEND, 98368 APPLICANT: RICHARD K DALEY SR PATRICIA H DALEY PO BOX 2051 PORT TOWNSEND WA 98368 SUBDIVISION: CAPE GEORGE VILLAGE DIV 3 Block: Lot: 42 PARCEL#: 940500041 Section: 13 Township: 30 N Range: 02 W CONTRACTOR/ DEALER INSTALLER: SANTIAM HOMES SANTIH*063L3 Expires: 6/6/2006 JASON HAMLIN AUMSVILLE OR 97325 PROJECT DESCRIPTION: NEW MFH /Champion Silvercrest Model 4703L MAKE: SILVERCREST YEAR: 2005 SIZE: 70 X 26'8 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 1/7/2006. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): + ' A/25/ G' Stormwater FINAL Approval: Blocking/Plumbing 6 a? -'OS Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: VFinal/Skirting/Vents/Porches/Steps: *Laing (OK, 6/z /05 ( ',d,G, \-Ai i 2--7--;5, 2 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 III SPECIAL CONDITIONS CASE # BLD04-00632 1.) The application was reviewed by the Jefferson County Department of Community Development staff on November 2, 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 ma ppininspection, the following ESAs were confirmed to be p es present lon the subject pro'Ind an perty site SUSC aquifer recharge area; coastal SIPZ. 2.) Aquifer Recharge Areas in Jefferson County are characterized by formations that allow percolation of the surface water into the soils porous 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.) 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. 5.) 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. 6.) 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. 7.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. 4 8.) VOLUNTARY MEASURES O OASTAL &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.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ: 1. Installation of a flow meter. 2. On-going well monitoring for chloride concentration. 3. Submittal of monitoring data to County. 10.) MANDATORY MEASURES FOR COASTAL SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirement: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 11.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 12.) The applicant is proposing to create or add 4964 square feet of impervious surface and 6892 square feet of land disturbing activities. 13.) 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. 14.) A Stormwater Site 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. 15.) 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). 16.) The site plan as submitted with the manufactured home permit application on October 5, 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 November 2, 2004 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 17.) 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. 18.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 19.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on y 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 requirement: 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). 20.) Maximum lot coverage is not to exceed 25(Yo. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 21.) The building height is not to exceed 35 feet. 22.) Minimum setback from Hemlock Drive right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 23.) 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. 24.) 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. 25.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 26.) An address of 15 Hemlock Drive, Port Townsend has been assigned to the Lot. Hemlock Drive is a private road (P71). 27.) The lot has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 28.) The lot was created through Cape George Village Division 3 Subdivision on August 27, 1964 under AFN 180841. 29.) A Declaration of Easement for septic easement on Lot 41 for the benefit of Lot 40 has been recorded on September 29, 2000 under AFN 437611. 30.) A septic permit(SEP00-0216) was approved. ' . _6 . ,,.. o • ' ••• 1 . mar, mow ) 2..:1-!,`,',`" PI- I ,, R *". • .0 I , lEil,.., I '''•121 i 1 lip v,- •• , cn N.) ii„,--.---:- a 8 le III 0 R _ 111 111111111M -014.- A111102K 'LI). ''' ir...R.:111:1-7°.!isr‘::1112-1 l'A.:111 . es,: E Tmmil.,.....mquir- DI il ,6113-672.1/111112111‘1111• (s, iii!!ill .,_ Illi OK. . ie, im......... - ,_ 90 1 m ....-: .„moriLqap- el . Iligimm 1 r 4 .., ti. - I i 17_ --- C-Jj _ . j_12 •lk" errnrins:, iidii .:. ' I 1- ---1,--1, il 37--. Itiratk- • a 1 ' :.--------, 1 r.ii , . s--id 0_, i ___, K. - minumm „ ....„..„. rviummiti r I, LD NA''"oile I 117.14111111111'a WCZ : non . , ....,1 ul 5-1--a I . Eillia- 1 IlMj . Nail ., o .... IIIIIMM • , -- LAi ----I , L ,. 7,q I 1 CA1 CO W . [t. b 4. t•-, Mg tz] -0 -..._ _I is) C:1 ! , IIIMIIIIIIIIIIMMIMIMMMIMMMMMMM -_ JACK WESTERMAN ID ASSESSOR Jefferson Co.Courthouse PO llox 1220, Port Townsend, WA 98368 (360)385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: XIGHAR!) t /}LEY ADDRESS: /'cam/ HEMLOCK ,bR1 V' PORT' TDLuAisEA1b, W4 9 ›, 6 PHONE NO.,3/,O - 60Cf -3J47 The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in ,Jefferson County or if it has been moved to this county from another area. 1►MOBILE HOME DATA: Copy (A)MAKE 04ArY1P/ON ba IfgRCk cr(B) MODEL hi 7O3L• (C)YEAR o?Gb3 (D)LENGTH 70' (E)WIDTH Q $ N (F))SERIAL# %i ' r/vc� by Fb�W44.s on''.T�eI.. Of lfA s (G)YOUR PURCHASE PRICE (Do not include sales x /O l0,39. 00 PURCHASE DATE fr/0-105-- 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE ADDRESS (B)WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes No If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. 3)WHERE MOBILE HOME IS TO BE LOCATED: (A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes e (B)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK Lot/Sp ace # (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: RI C j)jc}L6V LOCATION ADDRESS 167 NEML-0 CK &I c , Pa R P T5CA T e 9826 k' REAL PROPERTY PARCEL#/DESCRIPTION 74U 66'f I ,t,„.#14 1,Xxa )11 THANK YOU FOR YOUR HELP! i nature of applicant 6A SS Q Q d�^ ` 5 2095 JO COSSELL, Property Technician 41/ �4. SON c N '.O\. JEFFERSO OUNTY 4 ' \� lj DEPARTMENT OF COMMUNITY DEVELOPMENT t ► '; `d 621 Sheridan Street• Port Townsend •Washington 983 -'' 360/379-4450 • 360/379-445wa Fax �qSN°rS � O� www.co.jefferson. .us/commdevelopment k OCTQQj - 5 - i Master Permit Application MLA:;-: — JQ/ Project Description(include separate sheets as necessary): t ..: ��CCJ DOE(t) illA-0Uf��-c-7�[,f 148 A _ Tax Parcel Property // 700 so;Fr, � i Number: 94/0 S'00 1)cf! Size: ` �i(acr&squrl feet) Site Address and/or Directions t Property: /S J g/OIL Ce-k.1),J ,C'fi VIteAG Z iger dUk,1 ) ?8. te Property Owner(s)of Record: IC H i9-62.21 i�Q tC/i- i4t_ Telephone:,3(0 -60%-t3/<I7 Fax:N//1 email:t•icliard,.tie ie (y�warirMet Mailing Address:PO, .� 1_5"/ r lid er-Ta/a/6r , 0.1It C? -36 8 I�stt•t •-. v Applicant/Agent(if different from owner): 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]** ❑Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached ❑Special Use(Essential Public Facilities)** p,Manufactured Home ❑ Boundary Line Adjustment ❑Modular ❑Short Plat** ❑Commercial* ❑ Binding Site Plan** 0 Change of Use ❑ Long Plat** 0 Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis CI Shoreline Master Program Exemption/Permit Revisions** ❑ Stor wwater Management ❑Shoreline Management Substantial Development"* ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium *May require a Pre-Application Conference **Requires a Pre-Application Conference Please identify any other local state or federal permits required for this proposal,if known:E7ISEnteAI/S !'0R. bet til. (coY{9 WA`, Pr lCN><D jD3 f' /G (s Peg nttr W-,,2/ �j 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 costs,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 .rovide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any • ired later ins cti• Access and right of entry to this property shall be requested and shall occur only during regular business hours. 1 Signature: /J Ad /do, I' Date: q-.:).•'O The action or actions Applicant will undertake a 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 viol. - e ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if are in corn.'•. 'th the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non- Ins Ai ,o a r`..puns'•lip . .• - ng to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: A' 0' / Date: ,"2 2 0 ir G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc r' ,,, -, 4 s s :-•� OWNER BUILDER STATEMENT . ,I D I --b., ,. . - - ) ' r- The signer of this statement doe reby certify that ey are the Owners of the parcel referenced herein,that theyre not licensed contractors and that II they will b a in the r • i ity f the General Contractor for the proposed project. s OCT — 5 2004 Signature: Date: !' .e,;2 -O V i GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: - f=Ax: — ' 6,9nJr,A-fr' 44 t rjSo,1 ��i iou A) (5 3) 741,3- 3.2 9..� (,-5 3) 74/-1-33? MAILING ADDRESS: •a•sex /,33 9 4k/1,43 e/LA-E,OR 97.52,S'EMAIL: /)/A. CONTRACTOR'S LICENSE WAINS 6AN r1 // 0 4 3I-3 NUMBER 241r9 ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: it New .Wood Existing: 0 Sewer O Addition 0 Steel Proposed: Z. Bank 0 Community System O Alteration/Remodel 0 Concrete Total: 2 Height: g Individual System ❑ Repair 0 Masonry SEP Permit#QO /4 ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type otHeat: Proposed: 2 r Public fiStr�u�P �Qe. f4u, Total: Name of ystem:CAVE Fr14eef L TP' L1 If this is a Commercial Project you must answer the following: /J 4 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 ❑ Cook Stove ❑ Woodstove 0 Fireplace Insert 0 Hot Water Tank 0 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 Fpr Office'Use'Only rV _r:' ; '47 r �4 :€ , � Current Proposed �4y2 �tr" 5' - t `'4 : ` ** y ,.' , Main Floor 0 o ., Consistency Revie•W: , Yll 4 - ram: s r rAl, r •s «a; 2""Floor p Base fee: 4;. v. s 'fir. �kv. 3m Floor ,o 'Additional Section 'Y` `�'"ti' yy 't ",L: 4f j O4+s 7 4.i116l.7 , S F:e::- m::Y.T S , '" ,if,0^Y,pfr Mezzanine: ^ Plan Check'fee. ' 1'„1."iz 1� f g A*;.. .i4 M r{ vrt; x �k Heated Basement State`Surcharge fee: ?Y` x €_ �y. ' S 1 Unheated Basement Pot �` r� "� Water r ,'i-4. rt x= � Other Unheated O b 911/Rd � ,- ` . N` � �$ PRa Quit, ctm2 : u+ i I E x n •sstJ`'-,� `:4 Garage/Carport O 6 TO•. yr{ 41 -,«e q ,,t Decks 0 � 2eceipt Number �� " � a Other Cash/Check Numbed • r 'ts ESTIMATED COST(REQUIRED) Date: - ;: . s "' *Fairmarket value of all labor and materials foundation to finish t ' .z „ >7'111 Initials: .ok, "r�14 r r ., , *' N 0 G:\Pem»tCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc I . .. * • 410 _ .. °& JEFFERSON COUNTY 14 PERMIT # BID ft • * # \.°A DEPARTMENT OF COMMUNITY DEVELOPMENT , ;y, 621 Sheridan Street • Port Townsend • Washington 98368 0 4 - 6 3 2 O 360/379-4450 • 360/379-4451 Fax N http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# PROJECT/APPLICANT NAME: JC I C!t y€,/).Oi L,>l • 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. SE 6/TL ?Lim/ 73cHtb. .DNS r¢L-4 ,A)41/)0r4C T'4fiee f,/omE D P 0 6:0 ' CsJ ©t cJ LO ram' ALL NA—,dZ 0—,e s. . s7A2-�. ge.41/zij ei 1/Eu�.aY/PIfre c/.✓G-- 1kg-4 OF" /6d;0 5t 2 t i- 43.90,if 4F WITT1 'ssj 6*Ai€Z_./ Avz A /'u/ib c5 r.DEc•Jslzr<.Aiwa Jb £-lobvi E. Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. PRATger-5 Ire iQ Aar/ eaJ7 .Cor f}RE OuMM25b Sy,s'AzknE Men Es_ S in is G-FAJ2 4..y 5J-a PSI) ,a CocJ t .a u/e Ttf A -T7dd Ai tss ./Ua 2 egc s -A b sicheihtms. 6Lo/%ao Nor ExceE,O ANMAEe,1G . or 54.'/ ex.,.. .: I 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. 5/T� /5 A-zz 41,9. atC99/2A-35 —moo rkEe. —Alocli92.14,6S. 4. Describe the existing soils. Indicate soil type on the site map. vitn/dY aPSo/c, aA OMy/AJG-1 fP Tit s 6.`To 18' . Ci- V muss©/z__ To bE,,Tit c.r Car as AIMEI. oAJ 5(re- t2imnl. iiiz ( 0/'.5 /o ,cam .S►sP/ 560 /A/ Ctcr',9 PR-L. AO c5/71 . 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. O/re Grcnln 1 <SLo s R'cw <5E MILIAle46 Al id ,w tJ ftL. . IVo ER06/o0 . CaRT 4i101)RA/60 /5 /AJ3i1JLC. OM 6/7E Ala, RUNS E Tr, Lei ,4ce245s 6( 7E Ai-►D ArD.3,-/9-ct00 7-<.ar-Dint-D By.S►iis 9, U s . Rtid nFc /5 b 1,5 PFaeSE1 1 hiegOuc.4 04--wk-C( 6 OUE‘e__. 110' x /30 ' ®F t)(AW.s Ake i}. 6. Describe any excess levels of noise generated by the proposed use or activity: Ayi APPROVED STORMWATER PLAN NOV - 2 2004 Stormwater 's stormwater site plan template—rev.10/12003 Required JEFFERSO CO TY 5 DEPT.OF CV, D. EL ME T SIGNATURE: 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. C-&tJri / &oPrIJG. LDr• 6:/ /gyfeRfidE 4R. L65s S-oPE. C6(4-KE-AMAi de6,00) , 4)0 (5E105t rt t/E. aft_ Ca-t--r cA L._relk_ a'J �?t-+ . 1'}Z&ri c'r S rrE 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.). c5r rG is /(oc4;E4 //J ftinru <E AEA)/AE i i�1 AJE(G. ADAf�oaa 6 Y 5�fic►v1, R 0/t-D S, /frJ.J 1�291A114Co�. Fr9c/£./T/.€S ,4 i&E eeavEye.S►tii" f5i 7/L G4-Pe.- C 1 L l v C - (n ci-us). PDu1 e.,T€,c.rr pfaAl , rovvb CABL i u fi-R E k tar OvE2mu-b. 7-4.4 A-R .tlo S sc771/E oL C.R./riCAL,41 S coIrtI t %mILE, OF sire. . 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. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. O7bP u n ,Lin-.c- dt✓ this P,e23Eb 77tRoucs.h /Uhrc✓re.&/egss c✓qr2 i2t)k f3 'II 4 of}N Ck(si/06- Cu rt r- r N.t 2A Al (oF/4WP,OXflitR'TgLy °fob' /,5vaeses 1-77E4RS' 1.4) 4-DbrTi.n)14PeoPaSEb 6i45 r'1 ©F- AR4/n/5/9-rub A- DQY wat tj2JrLt. GIRRy Roof Rua0--7= To .A/sp sr oaf. (7a RPvtu/A- (-Ma- 3ce.f cL LL1 c]:iSQfie.sEb e i Be&Me:: r % 444Akb C Aritizs Multcsvr L.or, 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.] /04 11. Describe the performance goals and standards applicable to the project. I)(seiiesE .1-i 6room 1.1) R Aic Fr= t,J/rfff6U st Ta ,4-/tlb f4ZZt c6i✓T"1-or BouNawel e-s (2R,ss A1ln13>sC$96s1 ‘.5c4 pet..ryf€nl1E-D Ylecbdetrri le�1r4i irO' elr,),5P&ie.*4't)SuPP - -hieN7 By Ca kroi abbeiv as A- A Qy 06 ELL &)t'-.. 1 r©,e ek(Fr2 sT-6,e))1 cvr; .4 Rt,ct Oce /4-r✓A46m TSr-d-10.�rd 12. Describe the flow control system. • (57-5AAIWA-ret2 Qu VoFt= AL Re.N ruut-c-,/c)rsp6ks %/leece2-ff I Sd x /3 o,lJr i 6i/e- 6i2r6S. A-Lt:1/4_S'iQuet'u rE;ls s c.t,1-61 ay✓ri*SLt Res 1)4/09-Y Fedrvr ) iOn To a?7 /()4ruM . Ruitivffi p.AiS D BY ulA-Y DFCt&eiA4s 1)Q/4-1a1s i4iva i4DRy stormwater site plan template—rev.10/1/2003'• 6 • � 13. Describe the water quality system. 14. Describe the conveyance system analysis and design. 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. F 4-1- &u.L. Coma I o' Cci r_,t>s( r� PRii i A-Ry /4011C4 L.Cfffit'!¢CTE/Qls%/C'�f' /,s/*Nb Afo CL-Ary. TP"sv(i./ o Ai Cu T ,,t1/cam RE,d.s:p42s E. B vEe sad? eye..40E /}aou4b , [te rta.Es 4tJ D b13 PF4sg4) e vErc 4cri Gw ss %v L.Ev€c... �eieRss/.O r /5z-Lot/ Ottolss to GR 77lb([3M. l C.026711I G/VHl/jc. %4L4 SO Pitt Eour419,ti A,aii/G.ji,Nke 16. Proposed methods of placement and compaction consistent with the a�p plic�able stand rds on_Appendix Chapter 3 offtth_. 1 Uniform Building Code. ?j au&-cu g#49- .�I�4 fil"�E4 wiL( 6.€rya-kb W/rn , ALL , /C7i9. ?iQI CTt(W P,s fiiCCo Alb /A/6_ /S talc, a/1LL ve3E/919/L/E.to/x/ TF/j 4>1. i lo.A r /}l a Co Nt Per,Opt) DP /11-1- b i r.0 RMJ f9EE16 17. Describe the proposed surfacing material. �T f✓E-0/2 4S5 S',�E1 /9-S /¢UIl 1-.q�L E. fog Aim r/r,r d .6,0e Sf.D fi4e g s , 1. t-�t 4 i 11/e (- FDA l nJbse#Pr .. --/"G 0E4- f g ,took t ve h'p4,4Ai21 i/heKi4G-at3o<CA. 18. Describe methods for restoration of the site. ConIP1,P_r-/&A/ Of goo! . /A/s7ei44.4Tian/ e4reetfer. gR/fbc fu ki FAam l-v trE //v6 ivrr-F 6toP.TORE.= E -i i3igyo,1b soi,6Wr4-tg. RAOei-44 J C4gOE w/ri-i /49 i,/4 6 ; '* ;AS I g.&:`�e� l4'LG IREvYI,31A ,AJ c�/Ls %3 F'/LA- (*I bffpg . ✓4O,r/_s Bar f uta224/,-T/ � � / CO/v5i 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. PIS 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. N�p 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. AN .//r/er-efss s ci4SErn Pc/(J•r ,¢aUv /4-SE,0 7c usE_ EsE,vneitl?-,4ke a / e•inic / 95tos7c)oho Alva 9uo(500 off/, Nd 677f6".... PERnt/r,5 DQ APPgOve 3 14Ppz4e PR0.'I�ci-'. stormwater site 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 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. C4-Eiga Age. &I2KeA occr 0.4i -5(TE REA St r€ Pl Mill. 2. Establish Construction Access. Ikcks5 Tb R zc..i s rrE /s 1 R F.}S&MFAJ1 O/)dL2(40pv igrixkligb ,Ross >4JTAC€A/r LOT. /4Gc .s /s c5Arvle. A-6 GQsEZ Fc)2 c5E/�rc s ysfF-s///0115725C1-4J7DHl®� e t--- 944ti5oc oyo c-/ $1I r do d2/b - -'//'aefx/&..Wit-i- q,6/7ye Z ,'tn2 o4-1 PAIN >rc AA R CojQaL 116 �CA )T.e) soccny �2 Rj)ainoll>g c-. 7e) ' 3. Control Flow Rates. Ro (,'-c. 3g it1 .P.eet-c-e—A!(c�0ur,q l-ic4. u/nnviv "IfF t16 5/rg "ma 4 r /49e i -4 i . Ru,ic' Sra.eknaJALFz#, al(c LAvgAs liib2ou -t >/oo 1 oi=. TI 2*ss Ativo /iv:a EA ,s77A16 f moo Guar-9a/' h1.OTRA44.194cs AAO P6sr/cavE.s2iA.16..rdiib.2A fnrP4Ov61) 5t *4.4-+Z+ ?? A/&3o sfeiLE. 4. Install Sediment Controls. ksyr/TEa CGgfl.,ei zJ6- r."4`,4/�2Iic'/9C-- /Ofr— 2 SP,t=iC [.,/614 c ,AAtra1iq//ka/1/�i c.d(i H A l rM 1re.D Tim//eo-- 4CPdsi2M . elaeJS6/1— cc is c.8L S7 r/ac-1—yL/ryii r ¢e0/41 Arr-FGoc e>.(.5i—keeVA,LE aej ci i leeS Oelal P sic Ca r 06S ,d F X/rbet.y4.4 65140 u %, t' Azisg . 5. Stabilize Soils STi€ 3�c. �fflteie1 F6e-j sPk 4a uJ Mal-eh' ,4v a/a R P -sue c reivERiiiks w/Lc. Z d. Eim e 4.04E43 )45 Alg433t.b /0 de 80A 1/ut t1• TR/941 Pik/ Off/-St ii , 6. Protect Slopes. c5L0 S ON 6/TO-- 4 E 1l/ir/i/n,Sl[. . gPtAi SOl c... StO Pkkv 46/91 7aQ /i,ni 4 / ?& t-,L. t3>i. a i.W-i-r_b efy,f.s4oi& s Wi rrr-,4i 46.4e.ieL- /t 4-e lse . T tf , .,ijo .sLo t flP 3:/ og ogg crL Dal srriz. Nd esr— ESL-o(igS 01J 8ii I 1=92 O2 1——Ss 7. Protect Drain Inlets. Thlerga. A-Qe l) O -241N.l,t1Lies AA! OK A.ri3ortA1 . T o TA-0 P,..o. --r' si' ,. 8 storrnwater site plan template—rev.10/1/2003 • • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 7 p e1 2ocrre r co L Aid r abet_htiuY (/f•44t/, e- O►2 ur-- ;S, 9. Control Pollutants. ILL CDAJc,t€, ,gAl ODMXP er_L-4re /k7-'d!712S (�J/L,l� �,� COAT77-/it/Eil e.,/rhim/ r1ti ,DES,aA104.rresii fnRrrts MI.ts4. T 4I'I 6/zE 4,0 seoP,E j P i e_c___ PREce..uz#1. . y-V€tt!Ct-E.ylif/AJ; ,J,4iVa4 BAISi7 , ALL COAJSrnttr7at/ t..CWt� ES.E 4i.x,riW5 /o Ode COA ROZ-t-..D Ab e/9-7 J 6iiJ-St 77E. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). / / 672O 4.e+j t: ATex. /s E e CTre 1J OAJ %tf t s -sr 7'E.. 11. Maintain Best Management Practices(BMPs). AM KS OLN-c- ¢3g /h 4' Jr1,rt/ea QW 6/re /3 Y Dye C W Vi-croR r- 2 TheigL✓r o� Tic ►For -. A*L . r eo/c,¢ley -1 2 7744r AtE e npz_ov 6,6 Wii az / E i i e UP&,t)( oekip2_c,-7&A[ OF' DYE 12. Manage the Project. CIA)77t et Lid tL i-t3 g ©,t1 st rE i a¢o m ,E-,.iouiv/a+c,. Dr' Cabs 7 yecic riO4 io F7,/41.1_, CD CcOi"..IU-Tl o,�! r vA ©p E fit.t>`rre ?CT Cit/Sc lx_ AD i--¢ io Tn'Q srb u/.g- t/ U•rr 0 Pi.' 'J. Cb„/;R�c - cc//�r. /1lavi i . �t/o /Yki,✓,� . ,9L- f ►�4P�r/n.�-fJT/'-iri Aut 5Lacoklr�2r3-C reRs 4Ak-o ©A✓THE P2( c..j; 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). 4/40.r+ .r 5171E 15 LocA-r lnJ/914rixieE, ii6rboori n C a ?Ei;l 4/ir'r /wit r 1/4-i ' , ` 4460 7-1�� 771E. 2 ,flei kO 6a4t irl ye. Cie Clem,c'L 1st W/TY/,N )"y s is e� r1't 517r_/ ruR s$f s P, es/o.1 or co/mill7 E .c$x.cpst_E.ilg t/7rti k?y ccueng,,✓bce-e-,-t.s A ZRye+t/f l.L i'avaaE AA, ,s7l e/Mic>=, .r', i.A/r nay s b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 ya ds). r�eeirEcr&rE ins/Dc/frro M-B>c tiyguz. eES 6E, a 41( rea44,-i K0 a5 Nc) 13g,q 770 s . 6releniulctrc 4thireie`fr f�roin risk t cr irk ,v/t RE Jbrsilz4561 1 IJ Tr/a ire . /v.D/T drnce yr A07 . Or,1R aon OT,verr is/ c (4)1i b1 FDT SJS T7e/''Oc -i-I 4624/A/ACrf_rAzcz . 2e )4reti✓ AM_ Ostocrl ve-p)L Ce. -i C c-__ rill rI",1 ' rtw Y?eD er sr r-i 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. !.`5J stormwater site plan template-rev.10/1/2003 ` 1 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. N/, - 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure). 7-WE « No /M)8c&-rt1)a1 s OF Eecs/a-cJ P, eLdris 6't/ 77/ Ickes ker-$ir,E Q2. ,tu O7W E/ ?R TE -T Serg s /ry Thig.4 .7i9-cr 1Qfier1 . 27/e c5 -any cso/t., i S<�E., .t3g Cu.r� F/u- -t 7 Ct W-4, ne S P&sus Ale Poi EA/r74 wit Al �i2o13 L_Pr4is 5. Construction Phasing. a. Construction sequence (not/ f 5St.tA.IJC,e o i crtie B4ti-a/"le-fiile»s,r CAA(�i swrwo Ld k bravid f,olAiRuErl A /t cces s Ej c.14vA4Tt o o, U Tv. Ty/SEPi 1 L rtfaiZ t j CoIA/GRE !p46, bizta WAy/pAtictA)6-k4A COnij' -fn0tvt/-k iit F cIs:AtAArttNy Pito/LeryKetcarmiliv. 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. CpNansterto4 tAi t-SEAM ulron) 155u Arta OF rill 80 'rOND,Q A13dur QcroBee. 94 audy pNb Se.conApi,c-rra. ?ct THE Aim' SE4uEAkk, QN 04 0180cer74#ilumcy.er?Oyi II. Wet Season Construction Activities. a. Proposed wet season construction activities. jrr£CD+J ac n D4S W nit atop r, UF.GE r fr U E co_verktsE 4stith45/t GEvrLy &. pinll6- 14whscai&E. p F / f Y t E �ee 044 A3 Do rastr6f°PEp-"sea /�t r Hai s ructl rrati itres'' r ghVif en f reffAtsE#J6 rve afgeme• Po 4.CoMS e.rr o Swain Witr1Fi2 PLAAJ is ArrActin , b Chr#,J6 lkolimespoto 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. Rt ftaRD A t-ey b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. OVIe 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. KO a. Sediment Ponds/Traps. b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations to stormwater site plan template—rev.10/1/2003 • • SECTION II—EROSION AND SEDIMENT CONTROL PLAN Sediment and erosion control measures may be depicted on the master land use application plot plan,a stormwater site plan,and/or a separate Construction SWPPP site plan. This is a checklist to ensure that the following are depicted on a site plan: 1. General. a. Vicinity Map b. Jefferson County Approval Block c. Erosion and Sediment Control Notes 2. Site Plan. a. Legal description of subject property. b. North arrow. c. Indicate boundaries of existing vegetation(e.g.,tree lines,pasture areas,etc.). d. Identify and label areas of potential erosion problems. e. Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable). f. Show existing and proposed contours. g. Indicate drainage basins and direction of flow for individual drainage areas. h. Label final grade contours and identify developed condition drainage basins. i. Delineate areas that are to be cleared and graded. j. Show all cut and fill slopes indicating top and bottom of slope catch lines. 3. Conveyance Systems. a. Designate locations for swales,interceptor trenches,or ditches. b. Show all temporary and permanent drainage pipes,ditches,or cut-off trenches required for erosion&sediment control. c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts. d. Shows grades,dimensions,and direction of flow in all ditches,swales,culverts and pipes. e. Provide details for bypassing off-site runoff around disturbed areas. f. Indicate locations and outlets of any dewatering systems. 4. Location of Detention Best Management Practices(BMPs). Identify location of detention BMPs. 5. Erosion and Sediment Control Facilities. a. Show the locations of sediment trap(s),pond(s),pipes and structures. b. Dimension pond berm widths and inside and outside pond slopes. c. Indicate the trap/pond storage required and the depth,length,and width dimensions. d. Provide typical section views through pond and outlet structure. e. Provide typical'details of gravel cone and standpipe,and/or other filtering devices. f. Detail stabilization techniques for outlet/inlet. g. Detail contrcllrestrictor device location and details. h. Specify mulch and/or recommended cover of berms and slopes. i. Provide rock specifications and detail for rock check dam(s),if applicable. j. Specify spacing for rock check dams as required. k. Provide front and side sections of typical rock check dams. I. Indicate the locations and provide details and specifications for silt fabric. m. Locate the construction entrance and provide a detail. 6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained and illustrated with detailed drawings. 7. Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other than sediment(e.g.,concrete wash water). 8. Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for monitoring water quality on the construction site. Sampling stations should be located upstream and downstream of the project site. r.. • ,� yl t i' stormwater site plan template—rev.10✓1/2003 e 11 • • 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 the affected p perty. ( WNER OR AUTHORIZED REPRES IVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: 12 stormwater site plan template—rev.10/12003 • RETURN ADDRESS Richard & Patricia Daley P.O. Box 2051 Port Townsend, WA 98368 C1 STATE ,n WA HING STON CeFW T MANUFACTURED HOME PLEASE CHECK ONE CEnsJn� APPLICATION DTITLE ELIMINATION OTRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty REMOVAL FROM REAL PROPERTY of a felony, and upon conviction may be punished by a fine,Imprisonment,or both.(RCW 46.12.210) D MANUFACTURED HOME TPO/PLATE NUMBER YEAR 5)E Vie riyLENGTH/WIDTH(FEET), VEHICLE IDENTIFICATION 17-7 (VIN) _ 6 © LAND CG�(FCt�^! `�J7 IiI of, DESCRIPTION DESCRIPTION ON PAGE `/7,3 MANUFACTURED HOME WILL BE fit AFFIXED ( REMOVED IREA940E500x040/940E500 0411 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE 41 & 42 QUARTER/QUARTER SECTION Cape George Village Div. 3 © GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER I NUMBER OF REGISTERED OWNERS JI NUMBER OF LEGAL OWNERS NAME OF REGISTERED OWNER 2 Richard K. Daley Sr. DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Patricia H. Daley ADDRESS CITY STATE ZIP CODE P.O. Box 2051 (151 Hemlock. Dr) Port Townsend WA 98368 NAME OF LEGAL OWNER Richard K. Da.ley Sr. DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL LEGAL OWNER _ Patricia H. Daley DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE P.O. Box 2051 (151 Hemlock Dr. ) Port Townsend WA 98368 GRANTEE NAME I DO SO E NLY ATTEST NDER P LTY OF PERJ RY THAT I/WE M/ARE THE REGIST ED OWNER(S)OF THIS VE IC ND T IS INF M T N CC TE: J ( nature of Reglst rr d Ow/wj er an Title APPLICABLE t � ix, Signatur r#diti�nal`i e 1 red in-f4 n d ,IF APPLICABLE --el...) or Y EAL R TAMP NOTAR TION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATUR St Le of Washington Signed or attested /; 7 Notary Public ' r ((County of il20-1_ before me on (/ 11 / - 7 1 MART b c1,1Drdk 4 Pe Expires May 11.2 4? . I /c R PRIN ture /Q tc , MVAPpOIMI'TIYP}1 E RINT NAME OF REGISTERED OWNER NOTA Y O GENT 4 00A •— _• -_. _ b a f s: C . ii-p I „T.�RINT NAME OF REGISTERED OWNER PRIN ED NAME QF NOTARY Title County/Office No.OR /' DEALERSHIP POSITION/AGENT/NOTARY AND: Dealer No.OR 7' /I-vl D TITLE COMPANY CERTIFICATION Notary Expiration Date I certify that the legal description of the land and ownership is true and correct per the real property records. NAME(TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER I First American Title 360-385-1322 SIGNATURE/POSITION DATE ©Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. BUILDING PERMIT OFFICE CERTIFICATION I certify that: manufactured home has been affixed to the real property as described. Ming permit has been issued for this purpose and the attachment will be inspected upon completion. NAME(TYPED OR pivix D) BLDG PERMITOFFICE/PHONE# LCCL `ICH-X' I rti f 1 �]1 n 17y1 1�/�, BLDG PE�RM/-ITT#Y TIO �/ T DATE /�✓� ~-T6.42e•FittloTANUF 17010E-4P L(R/2/00)O IR"Paa of 2 '��� `1 J / \. • f00/ZOOZI 506-1E617602T XV3 ZE:OT MJ, 1700Z/TZ/60 • /7/7) .• 77 funP.•s Ca1AM L J_ I SE Ttc N. p \ I E. — — — — — CoNbto� ^ r p Ov Polr ----H. ---Y Trip u a -I x,,r-or.... q,o} / rip Q C► d` / 57u B -O O �.r, - - MT b I M��� O \I / VA '4 1 'v v' ;; ,•'N TP-A' oar • C:01 3s y(`NI i N ro' It' tn+ ; — — -- — -- ;l A 4 �-CµRT141ra pRk.N 1 t t N \.. ZOtI_,%. - _t 4 w ,..1, In ii/ , b , 1 'J /,s'/.r _ • , \ \ J !L ! .r . .• . ., _..,.i r I \ (. �i \'N"-^- — -. \l Y1► I \ _ .fir �a� \ � �, �„41 � , . 1 o ' Z rt-„ s ,,,,,:\\I\ 0 .ti '..p }Mid r, . - • J-tA/AUG ).)\ -' '. . .1. 4'.(rs .fr‘ \ L �, 7 •I F, 1 -. , F.- , , (-‘ -6P\7 , 1, I G 1 N ' IC)..R‘ ' y C • I U‘,..sm I Vil T o '\ '. ! A; �_ O • ' \ 2 s /-�0 , � ut N s/z7-/.3)-1 - .44-4 P t 3 6 , . )1 iz:p. • -... rill ,, '1 i 1 N V ° Z., 1 I T. - 1TT is N --C 4 Y '‘ M i 4 n O oT` �I 3 ." __ o p to \D,.. t 8 `' r • (k) 1--) 1 IA t , . 'A t \ rh E , A -I .. ' VL: , -r‘\ C.,.) • T ' pi b i • 71".• ..--1, n 0 RI m O /- 'i) . 1 1 Z s r c Z I C W i`J_ r y M (,. . .. F. . ._.., V .t . 0 _i_z)i ,