HomeMy WebLinkAboutBLD2004-00765 SUILDING PERMIT APPLICAAIIt N MR Review Type:
Type: l
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00765 Received Date: 12/6/2004
SITE ADDRESS: 161 CANAL LN
BRINNON, 98320
OWNER: JIM FANNIN PHONE: (509) 965-3632
CAPRI FANNIN
706 S 56TH AVE
YAKIMA WA 98908-4220
SUBDIVISION: OLYMPIC CANAL ADDITION 1 Block: 2 Lot: 5
PARCEL NUMBER: 980100205 Section: 21 Township: 25 N Range: 02 W
CONTRACTOR: TO BE DETERMINED PHONE:
REPRESENTATIVE: C D GALLUP PHONE: (800)888-8715
3726 PACIFIC HWY E
FIFE WA 98429
PROJECT DESCRIPTION NEW SFR W/ COVERED PORCH
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,133
VALUATION 185,000.00 ADD'L: 425 HEAT TYPE: HTP
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: DECK: 24 SETBACK: 50
BANK HEIGHT: 50
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PUD PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: 3 Prop: 2 Seismic Streams
Total: 3 Total: 2 Flood Way Floodplain
Routing Date: F&W Landslide
0,1n )04 . > Shoreline Aquifer
�.. Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: /� r • *ai e
Permit $1,469.75 BAC 12/06/04 68785 Aft ' ' !9/
Plan Check $955.34 BAC 12/06/04 68785
State Building Code $4.50 BAC 12/06/04 68785 MAR - 2005
Potable Water Application $52.00 BAC 12/06/04 68785 Jefferson County Planning
Total: $2,481.59 &Building Department
• •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD04-00765 Received Date 12/6/2004
SITE ADDRESS: 161 CANAL LN Issue Date 03/1/2005
BRINNON, 98320
APPLICANT: JIM FANNIN PHONE: (509) 965-3632
CAPRI FANNIN
706 S 56TH AVE
YAKIMA WA 98908-4220
SUBDIVISION: OLYMPIC CANAL ADDITION 1 Block: 2 Lot: 5
PARCEL NUMBER: 980100205 Section: 21 Township: 25 N Range: 02 W
CONTRACTOR: BEAULIEU CONSTRUCTION PHONE: (360) 866-4702
4309 STEAMBOAT ISLAND RD
OLYMPIA WA 98502
Contractor's License: BEAULC*052DH Expires: 7/22/2005
PROJECT DESCRIPTION: NEW SFR W/COVERED PORCH
CALL IN FOR THE REQUIRED SPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS: --( s' .2t
UFFER:
Footing: �) 45
/
Foundation: w �q���3/Z.y�SS
Stormwater FINAL Approval: /
Underground Plumbing:
Undergroun n ulati..:
Shear Wall : 0''J�
Framing: ;..ci/ -7/5 o
Plumbing: �/f as-
PropaneTank/ Lines:
Insulation: Cti)Lot -7 L7CS
Sheetrock:
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: i /,:,2 _i7�r6- fkcc �.Y--g,,.,
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 FOR CASE A BLD04-00765
1.) Any proposed tree removal should be reviewed by WDFW prior to clearing activities.
2.) Washington State Department of Fish &Wildlife commented on the proposal for impacts
to osprey habitat and recommended the following:
This development should not have a significant impact on osprey, provided they do not
remove mature conifer from the site. WDFW could not observe osprey due to the
migration time period. Osprey have already migrated south for the winter. Therefore it is
difficult to pinpoint the exact nest location from the subject property. According to WDFW
PHS maps, the nest is located immediately to the south of the subject property. Any
proposed tree removal should be reviewed by WDFW prior to clearing activities.
3.) As per the approved Eagle Plans received November 3, 2003 for Lot 12 and received July
20, 2004 for Lot 5, the applicant shall retain all known perch trees and conifers >/=24
inches diameter at breast height (d.b.h.). The applicant shall also retain >/=50% of
pre-clearing or pre-construction conifer stand with diameter distributions representative of
the original stand (>6 feet tall). Windowing and low limbing of trees is acceptable provided
no more than 30% of the live crown is removed.
This application was not sent to WDFW because it is consistent with the approved
SPAAD that included an eagle managment plan.
4.) 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.
5.) 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.
6.) 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.
7.) 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.
8.) 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.
•17.) The applicant shall comply with the recommendations identified in the submit
geotechnical report prepared by NTI dated August 15, 2003.
The following is a summary of the recommendations from the Geotechnical report and this
permit is subject to these recommendations.
A.-A 15 setback from the top of bluff
1. It will be necessary to maintain ground cover on soil areas in order to reduce erosion
from surface run-off. Any bare areas that develop should be revegetated. Native
deep-rooted vegetation that requires little or no irrigation would be most beneficial. Please
consult the on-line publications mentioned below for further information.
2/3. Vegetation on the bluff face provides stabilization to the bluff soils and helps remove
water from the soil. Existing established vegetation should be left in as natural state as
possible. If a better view is desired, minor thinning and pruning should be done in such a
way that minimizes disturbance to the soil and root zone ant that insures the continued
health of the vegetation. It may be worthwhile to consult a tree expert in this manner.
4. Heavy irrigation or other activities that would contribute large quantities of water to the
soil should be avoided.
5. Surface run-off should not be allowed to flow over the face of the bluff and cause
erosion on the bluff face soils. One way to mitigate this if necessary would be to construct
a swale or interceptor drain on the upland and direct water to a catchment area then to the
beach (or to the rock exposed in the lower bluff) via tightline. Please see the online
publication recommended below for more information on this subject.
6. Surface runoff from hard surfaces such as roofs, driveways, walkways and patios
should be controlled and routed to the beach (or the rock exposed in the lower bluff) via
tightline such that surface water discharge to the adjacent properties does not significantly
exceed predevelopment rates.
7. Silt fences or other sediment control devices may be needed during construction such
that sedimentation to adjacent properties does not significantly exceed predevelopment
conditions.
8. Drainage control devices should be maintained in good working order and inspected at
least once a year.
9. An engineered drainage and erosion control plan should be developed for this property
to address items 4,5,6, & 7 above.
18.) The Geotechnical Report completed by NTI on 8/15/03 recommends stormwater to be
tightlined to the beach. The small size of the parcel, lack of area near the house,
conditions of the site, and the basalt nature of the beach make the tightline appropriate in
this circumstance. This applicant shall submit designs of the tightline to Jefferson County
Department of Community Development prior to the installation of the tight-line to the
beach. The purpose of this requirement is to ensure that the tight line is adequately
designed to ensure that it will not impact the shoreline bluff or the beach. In addition, that
the tightline is constructed of appropriate material. This information will be reviewed as
part of this building permit.
19.) The Geotechnical Report recommends a tightline and the shoreline bluff is comprised
primarily of basalt so a tightline is appropriate for this proposal. The tightline would catch
all downspouts from the structure and convey the water over the shoreline bluff. The
tightline would be located along the northern property line where the bluff height is
approximately 10 feet in height.
The tightline should be constructed of a material (like HDPE or ultraviolet
radiation-resistant flexible rubber material) that will not be weakening through ultraviolet
radiation exposure and mechanical damage due to trees, rocks and debris. A more
durable material for the tightline will provide greater defense against the elements. The
tightline should be located behind the OHWM, anchored, and an energy dispersion device
should be utilized. The tightline shall be designed and placed in order to minimize visual
impacts to users of the beach and nearby waters.
•
20.) The applicant/owner and all future owners are responsible for maintaining anZfprotecting
the stormwater runoff tightline to the beach against damage due to normal wear, weather
exposure, and/or trees, rocks and debris. The tightline should be periodically inspected to
ensure that it is functioning properly. If and when damage occurs to the tightline that
renders it ineffective, the responsible party must execute the necessary repairs as soon
as possible and no longer than 30 days.
•
•
I:\F_BLD_Permit_Buildng.rpt 10/29/19
•
9.) A Stormwater Plan that includes tightlining stormwater to the beach as spec Ted in the
Geotechnical Report completed by NTI on 8/15/03 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.
10.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
11.) 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).
12.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
13.) The building height is not to exceed 35 feet.
14.) Minimum setback from Canal Lane right of way is 20 feet. Minimum side and rear
setbacks are 5 feet. Minimum setback from the top of the shoreline bank is 15 feet.
15.) Two off-street parking spaces shall be provided.
16.) The applicant shall comply with the permit conditions for RAP04-00154 and install the
road crossing.
•
JEFFERSON!COUNTY , ; f
teiii)16.
DEPARTMENT OF COMMUNITY ,
621 1 Y DEVELOPMENT
DEC
Sheridan Sty•Pon Townsend•W EC - 6 2004 t
360/379-4/50• 3sQl3 Washington g63gg i i_....
1 lie° www.00.)efFerson.we.s mm Fax
tx mdevelopmenf
Master Permit • ...!,--‘,',,,Arty
Application . __tie
Project Descriptiones tin separate sheets as necessary): MLA: ._4 /1 fli---_._
Tax Parcel �&- , �W
Number `i 8o j oo 3 o fq Properly SI/n•c donne
ar coo P� Si : 9/30 c.Sibs Address antitbr pert: 161 C.ANAL 4.N G r acseel
sglreKe tee!
Properly Owners)of Recent U r.. ) - o W p
Telephone: S® 7
Fesr
.ema
Mailing Address: 04 S S c /jug •
il:
APtalicantlAgent(M diet from owner}: •p, w(,)/
qiil aQ
Telephone* a e -ion- g7 r S For�2S
Malting Address: 3 c _ f� L _7; _ email:
h�"' i� A. tad.. IgP
What kind of permit?(Check each box that appNee)
is Building
0 Demolition Perms a VarlanPO(Mina.
®Single Family D Conditioner Use ICl()r or Reasonable C(d) or Eoafomb Use)
0o Garage Attached/Detached 0 Dtsue l Use, us or Unnamed Use Classification
0 Modular
actured N ome
0 Use(Essential Public Fealties)"
0 Commereisr• p Short IMrte '�^
0 Change of Use 0 Binding Site Plan"+
Cl Address 0 Road Approach 0 Planned Rural Long Plat
0 Propane Consistency Ana ~~ Vsr Residential(�Dent(PRrIaYM+endments
El Mewed'Yea'Use
0 Stfowmwater Management Cl Shoreline Master
❑Site PlanProgram Exam
Cl •
Temporary Use
ance Determination(SPAAD)• Cl0 Shoreline ant Substantial Revisions""
0 Whales;Telecommunication O Compr� ,ab„a lilanegernere Use
0 Dlsaict Forest Practices Act/Release d Six-Year Moratorium
U'1e fgOn County Shoreline Master Program Map merit
Please Identify any other local,st lt®or federal N• • a • -,
permits required for this oar
Proposal,f(known:
I hereby designate Al. �. ! NI-UP 0E3fONA 'N ' AGENT
hereby
SxaagutE to act as my agent In matters
an9 fo this aDDtiCadrm*parings).
1tAliW Dais:_��c S�oq
By aiming this tom'. •owns
his,for n Ws 'M 4 ji r agent attests Ina*we intonnation provided ilan
may to Mk. +►'• Any nun
and
falsehood a any pNa6ln et MO*by N ro in any attachments,is lulus and
I further respect to tills�a b the best or
elipeltSeS wee to
Indemnify
� .�hold Jefferson Count/ageloot al fab(stse joto aP,y fee paw
maimw r ad arlYo**- '*:. •
°t enl y b JaRerso^County end Its st Jegamon County se a nseuit of a b e°I.r•Prolontabas or moms mum of OM°""tb'g vt for lti a,court costs r"6ys of
and
3belaaxa _ ACCea®and+old of airy b ails propertyywe*webs and shag Dacron only during►ragman
business
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undertake as a moue of Me issuance of�_ or'lead b a rta a ntid'take elan fhb p mi may neDssocly linos
ss those toms
°�'Kc}a Any species ao that the are definecdcwo a sae l all as un law k the:
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and . . , - with the JAny Ips Calmly ual,pow or agency can the a tossup en behalf often an used species
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.�.. i s„ b surd oorttptyglp rdtl►� Applicant sC*nowfe s. The APramthat read eat flat �i9 as a hobs k Sur
signature: .,
and and dates it balm
GA•.,Ave! pOrtM , s FORMA/Joao iltamit Application 7-a4OWx Dab:
I •d tSE6-2 (DSO) N9IS3a I 9wIniIna dl1•id9 oa4Ilit ti0 90 oat!
OWNER BUILDER STATEMENT • `
The signer of this statement does hereby certify that ti, are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be asi iming the responsibility of the General Contractor for the proposed project.
Signature: Date:
mtc..
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: J® - x- J `61 01 v\-P6 p EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE
( ) FAx ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type
of Sewage
fa New & Wood Existing: ❑ Sewer Disposal:
❑ Addition 0 Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel 0 Concrete Total: Height fl individual System
❑ Repair 0 Masonry t� SEP Permit# 56 P o 4-o(oc sc.
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: - 3 Setback: 0 Private well 0 Two Party
TYp e of Heat: Proposed:
fi erg? ��.+• ' Total: So t IS 0 Public
Name of System: fii?6 iry
e,e-V4,417/e,G4'1041 rc,a4rs/
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current Proposed: -- Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed 3
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:
❑ Heat Stove 0 Cook Stove J' Woodstove 0 Fireplace Insert CA 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 , �� -t
q `�tit"Qffic�'�Jse flrily . � � , ,� .� , ��+w�f
Current Proposed = u --� t t� n�ti 4 - k
Main Floor ', -*r a ��f ,f
latency Rex�r t �4�' s Y
�
2"u Floor
,
Az�tional Sedior%; - ,
f
3 Floor -
'Plan.Check fee
K .,---,6-. .
Heated Basement +'' a r t $ 1 T' 1; -
Unheated Basement gg .�,,.,�
Other Unheated J, � � sl w y v. `tie ° '��' /, e
Garage/Carport r{ >. iW
v .
Decks /� : • . t } ,�f :f1. ,
CotJF G'.og ec� G asE:'s n xi s• ',,,`,.
Z_4- 11,��� wv 1� • 4r pp��
Other '"14r }fit' '' .,�iii„,,r + { 1 t a-
ESTIMATED COST(REQUIRED) • : - s;. `� ; .i ,
•Fair market value of all labor and materials foundation to finishis (JLC , t ,,,,,t , `. ,
_
G:\PeimitCenter\FORMS\DRD FORMS\Master Permit Application 7-&04.doc -
IiiiN"'c:"31\17 .1..
•
JEFFERSON ANTY k/ DEPARTMENT OF COMMUNITY DEVELOPMENT 1• , : . i' `4 621 Sheridan Street • Port Townsend •Washington 98368 ! .`! ' I )
360/379 4450 • 360/379 4451 Fax i
� �O� www.co_jefferson.wa.us/commdevelopment DEC - 6 2004 E[ i '
87NG I
1.
Master Permit Application
MLA: Oil_.,(6 t. .
t
Project Description(include separate sheets as necessary): ,_,.
),.l LU 5 >`►P.
Tax
Parcel Property 5 ' -i c ,t/moo
Number:
�80/ OQ o�
Size: 7/3 O G o r (acres/square feet)
Site Address and/or Directions to Property: I(! L Atl AL L.N . i'1Istii. 0 14 Jl4.
Property Owner(s)of Record: -3 u wt C qQi i 1...-.ANN!H
Telephone: Sar( - f7Z -.5-70 7 Fax: email: ,
Mailing Address: 7O6 ,5 S 6 74 ,4 . ygyeis ria (�/,/ (7 a6-
Applicant/Agent(if different from owner): G .P, �A4.c,rJ i7
Telephone: 860 - ggg -- $7 . 3" Fax: 253 ?oz- g3.57 email:
Mailing Address: - ► 3 726 — A c, ,c ..4 ' il'� G..).e 44r524
What kind of Permit?(Check each box that applies)
lit 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 D Special Use(Essential Public Facilities)**
❑ Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑Commercial* ❑ Binding Site Plan**
❑Change of Use 0 Long Plat**
❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Propane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance
❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Ad/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:
DESIGNATION OF AGENT
I hereby designate C. ,J). �+s' v# to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date: .7-) c..- 5/64
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 attorney'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
hours.
Signature: Date:
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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date:
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04-doc