HomeMy WebLinkAboutBLD2004-00784 0685
11UILDING PERMIT APPLICATION ML Revviewiew Type:
e: I
pe: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00784 Received Date: 12/9/2004
SITE ADDRESS: 1900 ANDERSON LAKE RD
CHIMACUM, 98325
OWNER: GEORGE BALASKI PHONE:
PO BOX 675
CHIMACUM WA 983250675
SUBDIVISION: Block: Lot: T 30
PARCEL NUMBER: 901103006 Section: 10 Township: 29 N Range: 01 W
CONTRACTOR: ALPHA STEEL BUILDINGS PHONE: (360)825-7768
1724 COLE ST
ENUMCLAW WA 98022
Contractor's License ALPHASB117PU Expires 7/11/2005
REPRESENTATIVE: ALPHA STEEL BUILDING PHONE:
PROJECT DESCRIPTION NW POLE BUILDING
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 38,640.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: Prop: Seismic Streams
Total: Total: Flood Way Floodplain
Routing Date: F&W Landslide
IQ/f (P.)q- - Shoreline Aquifer
Forest: Commercial r FRur
Type Amount Paid By: Date: Receipt: Approved/ ate
Permit $532.65 BAC 12/09/04 68744 MAR 1 8 2005
Plan Check $346.22 BAC 12/09/04 68744 Jefferson County Planning
State Building Code $4.50 BAC 12/09/04 68744 &Building Department
Total: $883.37
frcQe
• BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD04-00784 Received Date 12/9/2004
SITE ADDRESS: 1900 ANDERSON LAKE RD Issue Date 03/18/2005
CHIMACUM, 98325
APPLICANT: GEORGE BALASKI PHONE:
PO BOX 675
CHIMACUM WA 983250675
SUBDIVISION: Block: Lot: T 30
PARCEL NUMBER: 901103006 Section: 10 Township: 29 N Range: 01 W
CONTRACTOR: ALPHA STEEL BUILDINGS PHONE: (360)825-7768
NICOLE STARKE
1724 COLE ST
ENUMCLAW WA 98022
Contractor's License: ALPHASB117PU Expires: 7/11/2005
PROJECT DESCRIPTION: NEW POLE BUILDING
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS: Clk 3/#5fr
UFFER: ,()p
Footing: j-sr ia1- -s D,f� 3/ /03-
Foundation:
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall :
Sheathing:
Framing: •y/.5: —
Plumbing:
Propane Tank/ Lines:
Insulation:
Sheetrock:
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval{. /-2 0%_,
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 BLD04-00784
1.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the
Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the
Landslide Hazard Area.
2.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated.
Should buffer disturbance occur during construction, the Unified Development Code
(UDC)Administrator shall require replanting with native vegetation. No alterations shall be
made to the Landslide Hazard Area or its associated buffer without prior authorization by
the UDC Administrator.
3.) Prior to and during approved construction activities, the perimeter of the landslide hazard
area buffer shall be marked with a temporary sign. The sign shall be placed in such a
manner that it can be directly observed from the construction area. The sign shall contain
the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter
Existing Vegetation."
4.) All construction activities shall not encroach upon the buffer. This includes the storage or
preparation of materials.
5.) The applicant shall permanently separate the boundary of the Landslide Hazard Area
Buffer from the remainder of the subject property through installing logs, trees, a hedge
row, or any other prominent physical marking approved by the UDC Administrator.
6.) 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.
7.) A Medium Stormwater Plan has been submitted and approved by the Department of
Community Development. Once the subject permit has been issued the applicant shall
fully implement the provisions of the submitted plan and contact the Jefferson County
Department of Community Development to arrange a schedule to inspect the property for
plan compliance. A Certificate of Occupancy will not be issued until the Department
verifies plan compliance. No clearing for roadways or utilities shall occur on the project
site until clearing necessary for the installation of temporary sedimentation and erosion
control measures have been completed.
8.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
9.) 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).
10.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
11.) The building height is not to exceed 35 feet.
12.) Minimum front setback is no less than 20 ft., side and rear setbacks are no less than 5 ft.
If an environmentally sensitive area (ESA) is present, then the more restrictive setback
shall apply.
13.) 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.
14.) 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.
15.) Stormwater shall be retained and infiltrated on site. The owner shall control all
sedimentation and erosion on the property.
I:\F_B LD_Perm it_B u i ld ng.rpt 10/29/1999
7.f
JEFFERSON COUNTY
..4"ir I 1 I DEC - 9 200
4 - $4. 'A I DEPARTMENT OF COMMUNITY DEVELOPMENT
j, ,, , , 621 Sheridan Street • Port Townsend -Washington 98368
360/379-4450 • 360/379-4451 Fax
TNC' http://www.co.jefferson.wa.us/commdevelopment!
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MIA# Cr -"'(c2 ) PROJECT/APPLICANT NAME:
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.
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
tio
101
3. Describe the existing vegetation. Indicate native vegetation areas on the site map. 0 #C
4,4 5.Q t-cz L - 6 rei s - f:e(-4,1 S, 41,,,r4fie! ..
4. Describe the existing soils. Indicate soil type on the site map. -4f rO v 75CH., /\j � t
Dee,
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.
(VA
6. Describe any excess levels of noise generated by the proposed use or activity APPROVED
/4 S I•ORMWATER PL
lAN
MAR 1 6 2005
storrnwater site plan template—rev.10/1/2003 JEFFERSON 4'Ol iy - 5
DIPT of cc to Di;VLI. P. !NT
Si%;tiAlrrRl:: x
•
7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams,
steep slopes,etc.)on the site. Indicate location on the site map.
8. Describe the general vicinity of the site,including adjacent land uses and structures, utilities, roads,and sensitive/critical areas
(streams,wetlands, lakes,steep slopes,etc.).
/es.
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.
4.J• 1 /
10. If the project requires the use of stormwater treatment facilities,describe the types of stormwater treatment facilities proposed
for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is
normally for large*projects or projects that involve the potential for dispersion of contaminants.]
11. Describe the performance goals and standards applicable to the project.
ti r - Lt'f2 -t'r I-G,` h e fc rec-( `41G( j� e.%c t( t y '.1./Ol Nt'f yt�7 Lc'ttsir
12. Describe the flow control system.
, C,
I
stormwater site plan template—rev.10/1/2003 6
13. Describe the water quality system.
/', 4
DEC 9 2004
14. Describe the conveyance system analysis and design.
/VA-
15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
Zvi
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
/IA
17. Describe the proposed surfacing material.
7
18. Desc methods for restoration of the site.
S e'c--ctt� it r' ,),
11
. .
1 .
19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for
large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals
here.
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
/1
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.
7-,i/f. A .
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.
2. Establish Construction Access.
3. Control Flow Rates.
/CI Cr, F /c,c -'
4. Install Sediment Controls.
I L4)/07/ / f c d r :f vl.Z L j
5. Stpilize Soils.
6. Protect Slopes.
71/VA-
7. Protect Drain Inlets.
8
stormwater site plan template—rev.10/1/2003
•
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
DEC - 9 2004
9. Control Pollutants.
tin
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
4.7>
11. Maintain Best Management Practices(BMPs).
V
12. Manage the Project.
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas,roads).
/?f,t4-`
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
/144
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
stormwater site plan template—rev.10/1/2003
9
b. Description of special requirements for working in or near environmentally sensitive areas.
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).
5. Construction Phasing.
a. Const tion sequence
/'i
Ai-
b. Constructionn/ 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.
Il. Wet Season Construction Activities.
a. Proposed wet season construction activities.
b. Proposed wet season construction activities for environmentally sensitive areas.
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
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
stone water site plan template—rev.10/12003 10
•
Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan,the proposed revisions shall be
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems,treatment facilities,flow control facilities,or structural source control BMPs
(not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as
constructed.
APPLICANT SIGNATURE
By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of the affected property.
Z
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
DEC - 9 2004
stormwater site plan template—my.1W1/2003 12
• 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
they will be assuming the responsibility of the General Contractor for the proposed proiect.
Signature: :-.,.-c — ,t;•4.;,q Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
M i AILING DRESS: f l d `4�ell
t� C�1 °�n' (3J LG)GS W 7 b` J(a'�' ��S` S J $j I
CONTRACTOR'S LICENSE I WAINS -
NUMBER: PC\9�Qt'�4\\.1 Q V NUMBER
ARCHITECT/ENGINEER: ,I�'l�p ,,J( PHONE ) C
MAILING ADDRESS: ` , (it i� ''i N.] EMAIL Y ) 3��b
gLUVct A `l 5-31
Project Type: me Type: Bathrooms: Shoreline: Type of Sewage Disposal:
3:1-New ❑ Wood Existing: / ❑ Sewer
❑ Addition la"-Steel Proposed: / Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total:,' Height: , ❑ Individual System
❑ Repair Cl Masonry / SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback:' 0 Private well 0 Two Party
Type of Heat: Proposed: ❑ Public
Total: Name of System:
If this is a Commercial Prolect 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 I 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 ❑ Hot Water Tank ❑ Pellet Stove ❑ Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to Install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage "For'Office'Use Only ��.� t s s= ,�
Current Proposed Amon "' �� -�i; -i Y,
Main Floor Corty Review: ' 1 I F
xi LC fix lam ;,, ,
2Nt,Floor fee ., -F i,er 4,,
s ti „ ,� g
3rtl Floor ed,,,..4„..,,,....... ,,
, . 7, t, .� .. ,, , A,}}'
�J.4l. — 5v" sgt. � ���r�s.,
Mezzanine: Plan�ie } t �
Heated Basement ~ y •
State Suf * " r ;4 -c`;; '
, a,�,„
Unheated Basement 1 �IIi''' ..�� -a, `k " ''. � `cad;
,- {,'lei Tl1 0 �.b" �'l
Other Unheated 911/Rd • •• l'"°< " ;I. V
Garage/Carport ' L ti i ,' `, e .::
tom,�, r ,�5., � �`. k� ..t'4'
•
Decks : r e A'
1 f y;i�
`R,a�pt dumber x i T O' 4,� ",� +`
Other hl Nct 4 „' �' _ a k ., s
,� t- f r�� yt. ii
�e i "` _-x 'tr.:.14.E ro "#S4 ii
ESTIMATED COST(REQUIRED) r qM t
f 1' 1ww r ' c aN 14 P
.Fair market value of all labor and materials foundation to finish • A� ,. ti w xtx
Ay—� 3 0 " `'0 'InItia u� l Pw � '.� ,,fix``
G:\PetmitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
„ ON 0
„-- o .� JEFFERSON COUNTY
' DEPARTMENT OF COMMUNITY DEVELOPMENT
ra
` `Q 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax DEC - 9 2004
�' p/ www.co.jefferson.wa.us/commdevelopment
�`S�t7NG` '
Master Permit Application MLA: r_sCONt-• t 3
Project Description(ink]rde sepa to sheets as necessary):
Tax Parcel Property
Number: 7 2/10 300.E Size: 77 cre square feet)
Site Address and/or Directions to Property: \Ci 0 C \ell.rS \!z c c)e •
Property Owner(s)of Record: 6cx rc)c: Vl a 10 sr i
Telephone: `)Wa "-) 3 3. O-4 -) 0 Fax: email:
Mailing Address: 1 c, 0 n oil A r-S a- ' \ t. f ek-
Applicant/Agent(if different from owner): ) t w 1-1 . S-iz�
Telephone: .. l.,C. c.--)S 1.7 1p S Fax: 3'0 SD--c 3 ' g i email:
Mailing Address: 1 a Gd\_.g._ S-1•• e rti V WM C.\riw-,” 1 t-' (~' -0....
,
What kind of Permit?(Check each box that applies)
61uilding ❑Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]**
❑Single Family 0 Discretionary"D"or Unnamed Use Classification
Iarage Attached/Detached 0 Special Use(Essential Public Facilities)**
❑ Manufactured Home ❑ Boundary Line Adjustment
❑ Modular 0 Short Plat**
❑Commercial* ❑ Binding Site Plan**
❑Change of Use ❑ Long Plat**
❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)IAmendments**
El Propane 0 Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
0 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 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:
Ake-{
DpIr�4A-CAL r 4 act O AGENT
I hereby designate f��t.2/J ,� � / tir�g act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE�'.�/.���'tey �e2Z-424.. Date: /2 `?`C y
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 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: ,//..-Ze9e- iC 7S0'--/�3L1` _' Date: J 2 9._011
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 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-transfera le responsibility fora erin to a and.complyinga vith the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: / -e-e51— /( / s- ' - Date: Z r Qe--)
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
...„...._...............
SITE PLAN . _ .
rnr
' k' JAN t A 0 I-'1
MAR 1 6 2005 ,,,, ... ........,
_ ': , ', ,-, ' .'•,:1:'''k'.! ... 14 toT
JEFF SO 0 e-
DEPT.OF C C
SIGNATURE:
C h l't,k en
&lope} Pit. 6..s"Z '
.....
i '
N
14 \
"1 "1
7...,....-- oc s e C5..n---
,
,
i
5-13 il-etitI
,7
SC'to r
_ --... \\\R\L.4)
„...--.......---,
2
1101160 4rve'd [ 1643i,
\ Vz 1 p
`Ple40 Cs'•.,.fc tZli
--zsd:2,, ,ep4 it- 4- PrC1 ihV‘..e1•411 (7% N\ *:N
k
\ /\ ‘
44 /
--.s,
(IN
‘3/\
• 4Z /A r /
....,
-, tv
c... ‘P
...} A
'0
i
/
\\
%
/
11"
/
c
tc-
I
/
S I ai sZr"
ce 1 1-e : ) /- ,.0 ' .. . _
. . . ,
ta V
. all CO bh...1 , c.,I,
l'"fti J 'II
t 11
ifeirkie ocvsi er ec"'"9e 13 q/q 5 k I '
CZ CZ:* .. Ifil
16.ft C....1
/qa Ire 5 //9400 I-i4der5061 l-t(. Ay,
,...,.._...C. l:p' .Ple? .c..444 &CI g Sv 3 25 Auk, c0.2 , - :
,,,
, it et
Parcel. tVC), 9, ' /le, •?e,o