HomeMy WebLinkAboutBLD2005-00316 • BUILDIN •
G •PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00316 Received Date 05/16/2005
SITE ADDRESS: 294 SUNSET BLVD
PORT TOWNSEND, 98368 Issue Date 07/20/2005
APPLICANT: STEPHEN R BLAIR
BARBARA J BLAIR PHONE: 425-830-5847
17009 NE 35TH ST
BELLEVUE WA 980086107
SUBDIVISION: CAPE GEORGE COLONY DIV 2
Block: 3 Lot: 11
PARCEL NUMBER: 938100310
Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: LD RICHERT CONSTRUCTION
PO BOX 127 PHONE: (360)301-0543
PORT TOWNSEND WA 98368
Idrichert
Contractor's License: LDRICC*066L0 Expires: 5/29/2007waypoint.com
PROJECT DESCRIPTION: NEW SFR W/ATT GARAGE &
A/G 500 GALLON PROPANE TANK
CALL IN FOR THE REQUIRED INSPECTION THAT APPLY TO YOUR PROJECT.
SETBACKS: DK icy, /a,
UFFER: Alo
Footing: /) /% ASP
Foundation: O 3 -p'
Stormwater INAL Approval:
Underground Plumbing: Ae l�j, t« t/�SL '
Underground Insulation: —/ $_c"•75-
Shear Wall :
Sheathing:Framing: C ,..1 fin--; 0411403
Plumbing:t 't,c y., •it'1i67I"7zrtl
Propane Tank/ Lines: 0 t'j 9 Mr)
Insulation: ge �5[ RC- ; 1,v ` Rc & b1/4)4-7 .e)&
Sheetrock:
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: '� 6 11 c.7
HEALTH DEPARTMENT AND LIC WORKS APPROVAL REQUIRED PRI
OR 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 CIPE # BLD05-00316 •
1.) 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.
2.) 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.
3.) The development will be serviced by public water and a well will not be utilized. If a well is
required for potable water the applicant shall meet all of the Aquifer Recharge and SIPZ
conditions.
4.) 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.
5.) Stormwater shall be retained and infiltrated on site. The owner shall control all
sedimentation and erosion on the property.
6.) 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.
7.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
8.) 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).
9.) Pre-existing legal lots of record less than one acre in size in Rural Residential districts are
subject to the stormwater requirements in UDC Section 6.7 and must meet the "Area of
Impervious Surface Coverage"to the maximum extent practicable as determined by the
Administrator." Lot coverage is defined as amount of impervious surface, which includes
rooftops, driveways, concrete, etc.
10.) The building height is not to exceed 35 feet.
11.) Setback from Sunset Blvd.right-of-way 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.
12.) 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.
13.) 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.
14.) A minimum of two (2) on-site parking spaces is required for the single-family residence.
I:\F_BLD_Permit_Buildng.rpt
10/29/19
IUILDING PERMIT APPLICA16 MLA05-00300
Jefferson County Department of Community Development
Review Type:I
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00316
SITE ADDRESS: SUNSET BLVD Received Date: 5/16/2005
PORT TOWNSEND, 98368
OWNER: STEPHEN R BLAIR
BARBARA J BLAIR PHONE: 425-830-5847
17009 NE 35TH ST
BELLEVUE WA 980086107
SUBDIVISION: CAPE GEORGE COLONY DIV 2
PARCEL NUMBER: 938100310 Block: 3 Lot: 11
Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: LD RICHERT CONSTRUCTION
PO BOX 127 PHONE: (360)301-0543
PORT TOWNSEND WA 98368
Contractor's License LDRICC"066L0 Expires 5/29/2005
REPRESENTATIVE: ANN RAAB
606 ROSEVELT PHONE: 360 385 5614
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION NEW SFR W/ATT GARAGE &
A/G 500 GALLON PROPANE TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION 289,343.00 MAIN: 1822
CODE EDITION: 2003 AMYL: HEAT TYPE: RAD
OCCUPANCY: R_3 HEAT BASE: 1,120 HEAT TYPE: PRO
OCCUPANCY: UNHEATED: 420 #OF STORIES:
CONST TYPE: 5N OTHER:
CONST TYPE: GARAGE: 522 SHORELINE:
DECK: 314 SETBACK: 85
SEWAGE DISPOSAL: ALT BANK HEIGHT: 80
WATER SYSTEM: CAPE GEO
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 3 Prop: 3
Total: 3 Total: 3
Routing Date:
Type Amount Paid By: Date: Receipt:
/► [� v /Date
$2,057.75 BAC 05/16/05 73079 A r r VE 0
Permit
Plan Check $1,337.54 BAC 05/16/05 73079
State Building Code $4.50 BAC 05/16/05 73079 JUL 2 0 2QQ5
Potable Water Application $53.00 BAC 05/16/05 73079
Jefferson County Planning
Total: $3,452.79 : Buildin, Department
IP' /
1Oa-- '"s.: ;► :A-
FROM • FR,�f NO. May. 11 2005 03:33PM P1
4141.°le t~a� JEFFERSON COUNTY ��, G I � I t e,
‘ ' it'A DEPARTMENT OF COMMUNITY DEVELOPMENT i
I
a
621 Sheridan Street•Fort Townsend •Washington 98 MAY 1 6 2005
(i
360/379-4450. 360/379-4451 Fax G
�,�0 www•co.jefferson.wa.us/commdevetoprnent -
Master Permit Application "-MLA:
Project Description(include separate sheets as necessary):
Tex Parcel :v/�T j��l-!��! _ C,�/�,�cL�
Number: ? 6' j I a Size:
Site Address and/or Directions to Pro (acres/square feet)
Property: lj i~��r' �L�0
Property Owner(s)of Record:� -p o le it R gn2.A 13 LA 1 fL
Telephone: z= ° yY 7 Fox 3 c;,," 3,9 5 <25 3 G email:�� n w)O
Mailing Address: _ y.=r7P%c �' 1 e�„S;.r��•C
Applleae11Agsnt(If different from owner): A,t-„y 124 A. 3 •--
Telephone: 3 lz S' -3 5 /./ Foe _____
Mailing Address: r!o Q!_i /rep S e•e4 7- f=�d 2 r %'L.,.)Au s �Az. email:
What kind of Petmit?(Check each box that applies)
r1 Building 0 Variance(Minor,Major or Reasonable Economic Use)
D Demolition Perron
�jI11gle Farrt3 __ C Condtionaf Use(C(a),C(d).or CJ**'
fl G n /Detached C Discretionary'Tr or Unnamed Use Classification
0 Manufactured Home Special Use(Essential Public Facilities)**
ri Modular 0 Shortrxfiary Line Adjustment
t7 Corrunar ial* Plat"
u Change of Use 0 Binding Site Plan*"
U Long Plat*•
❑,ddrese r1 Road Approach _ 0 Planned Rural Residential r�Propane 0 Plat Vacatipn/Alteration TM Development(PRRDyAmendments*'
r Allowed'Yes"Use Consistency Analysis f7 Shoreline Master p rogram r7 St water Management ❑Shoreline Management Exemption/Permit Revisions""
u Site Plan Approval Advance Determination(SPAAD)* n therein Ma g Sloane Development
0 Temporary Use Management Variance
n Wheless Telecommunication* 0 Comprnsive Plan/UDC/Land Use District Map Amendment
o Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
May► cult*a Pr•-Application Conference
Please identify any other local,state or federal r* ��a proposal,Pre-o i ftk Conference
permits required for this if known:
I hereby designate 44 h 11, cz--b DESIGNATION AGENT
to act as my agent in matters relating to this application for permit(s)_
Ow1NER SIGNATURE r '. Date: 5 /l/ /2° r,)-^
Sy signing trig appitoatton form,tit•Ownerlagant art that the information +
his,her or It's knowledge. Anymaterial provided made b.and in arty attachments.Is tale and correct lo the best of
falsehood or any omission of a matsridl fact by the owner/agent
may result'Mills permit being null and void. g2ttt watt respect t0 this application packet
I further agree to save,indemnify and hold harmless Jefferson
��which may in any way accrue aft Jefferson County
agresult
as o in eciies,juenceof earl thisreasonablep attdmey's fees and
I further agree f4 provide as a result of or n cotttoGtrenoe of the granting of this permit.
amass and right of entry to Jefferson County and its review and any requfrad Idler insaoaions.Access and righterttpioyall requested
representatives and or a occur for the sole Pu ose of a
hours. of entry to this Property shed bePp6piiarn
requested shall only during regular business
Signature: C ,i i
Date: J !
' The action or actions Applicant will undertake as a resit of the issuance of this endangered species and could lead to a potential"fake'of an endangeredies those nag are defined upon one or more known as the or
'Endangered SpeciesAct or'" A.-Jefferson Countyspecies a5 karma are defined in the federal taw known as
permit has been Issued will not violate the ESA no assurdll0es to the ePpaud that the actions that will be undertaken
permit )even ifn you are Corti 6a Any Indiviiduai,group or agency Can file a lawsuit on behalf of an endangered because this
and n(s)even
you P nce with the Jefferson�y development code.The Applicant acknowledgesa speciesd s individual
yourl
I bii' adhering to and compl)e g with the ESA. The cant that he,she or It holds Wdua!
sign atwnz , Appi has read this dtsc(airrter and sgrtS and dates it below.
date .a i
c.):\PoTriiCenter\Foams\I)RUFOR] ik—r, Ap,1:arriou 7•SUidne �—
OWNER BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,tha iheY,larEjnot ticenSed contractan
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature:
Date:
r-., t ,, y \, °�� that
'
MIN
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: illitIllgaimigil
PHONE: FAX:
ti /) /'/ /le:: ( )
MAILING ADDRESS: _
L
CONTRACTOR'S LICENSE �/, / C, C -6.2 C �`l) EMAIL:
NUMBER: WAINS _._..._, ��..._
NUMBER ARCHITECT/ENGINEER:
/ PHONE MAILING ADDRESS: f� / 7 ( ) FAX:( )
EMAIL
Project Type: Frame Type: -
New Bathrooms: Shoreline: T- Wood Existing: Type of Sewage Disposal:
CIAddition ClSteel Proposed: ❑ Sewer
0 Alteration/Remodel ❑ Concrete Total: Heg ❑ Community System
CI Repair ❑ Masonry Height;, ❑ Individul
System
❑ Demolition Permit# /,� '
❑ Other. Bedrooms: /
Existing: Water Supply:
Type of Heat: Proposed: �} Setback: 0 Private well 0 Two Party
��9 P r f N Total: —'=s r' 'ublic
Name of System:
If this is a Commercial Project u must answer the followin :
Number of Parking Spaces: Current
Number of occupants(includes owners,tenants,employees,etc�Current Number of ADA Proposed
Spaces:
Paces:
IBC Occupancy: IBC Type of construction: Pooposed
If this is a Propane Tank and/orAppliance Installation rmit mark all items below that aWill you have Fo Food Service? Ye s / No
0 Underground Tank l�'Above ground Tank
LI Heat Stove ❑ Cook Stove Size of Propane Tank: .";4z(
d Woodstove V Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other
Is this a liance bein 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,
includin the reserve area.
Square Footage For Office Use Only
Current Pro osed
Main Floor
Consistency Review: Amount
2 Floor /� 4 f �
� � Base fee: `I'
3` Floor r
Additional Section: J
Mezzanine:
Plan Check fee:
Heated Basement 155 c-
lob
i/2 c> �,^�State Surcharge fee: r-
Unheated Basement l(1'
�� i Pot Water Review fee:
Other Unheated VY-'
cp/Rd Approach fee: ,.s ..
Garage/Carport _ _
2 Z •
5 c , TOTAL: $ �:
Decks ,
; i�v. �C p
Other y R1 t Number
Cash/Check Number:
ESTIMATED COST(REQUIRED) / o ajr1 (�j
•Fair market value of all labor and materials founda on to finish CI i 3�3 e.
c.
G:\PeirnitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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•
fry
JEFFERSON COUNTY
s-s . DEPARTMENT OF COMMUNITY DEVELOPMENT
Apbtzt,. 4621 Sheridan Street • Port Townsend •Washington 98368
0 360/379-4450 • 360/379-4451 Fax
http://www.cojefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
IMLA# 0 3:90 PROJECT/APPLICANT NAME: 4 F-EkIE `� ,_
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.
A i 17 Si c g k Pc�u c fi2e•-.sr by c `('v
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
GO�t TJ ;L H t r Cu La-1"o Z ColtQ its.
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
4. Describe the existing soils. Indicate soil type on the site 0 map.
o C o t'r&.. V roc- '"apt
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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.
ftT rtt£'(- Ft c> r- mfc, ""
6. Describe any excess levels of noise generated by the proposed use or activity:
Vore
APPROVED
STORMWATER PLAN
JUL 19 2005
storrnwater site plan template—rev.10/1/2003
5
JEFFERSON C UNTY
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SIGNATURE:
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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.
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8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads,and sensitive/critical areas
(streams,wetlands,lakes,steer slopes,etc.).
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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.
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.
12. Describe the flow control system.
•
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stormwater site plan template—rev.10/1/2003 -�-�-• a L'14.1a101.1"4 ii/,:itn."41,3 0 T4 i+i
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13. Describe the water quality system.
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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.
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Unifo Building Code.
Pf� '-
17. Describe the proposed surfacing material.
it
FA.u✓T 4S,of DtLut To F,0 ,race ?Gael 7)i t,--, To Ai-cou>
n.G 'At,C. f7i pr,,,ee-,,e n,
18. Describe methods for restoration of the site.
C 9e4ot7'rrT- Di4,ThL3cv 5 1.,,�,T4- ppc--j 1 t) to.G.
19. An Operation and Maintenance Manual is required for each flow control and treatment facility.
equired for
"large"projects only and only those for which facilities are required to control flow or treat off.]If included,list is is normally rthe Manuals
here.
‘1111 -
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include
conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or
restrictions here.
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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. ►?E v A-DD. rip f,�+
Cc.c v IV do rt.�rrr-�-1
2. Establish Construction Access.„y
3. Control Flow Rates c.iPTtL
4. Install Sediment Controls.
�--� ti ter e'
5. St."'c Soils. /i (4y rli"•
6. Protect Slopes.
)v - 1,40"
7. Protect Drain Inlets. .
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stormwater site plan template—rev.10/12003 r�
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12 Required Elements-Construction SWPPP(continued)
8. Sta ilize Channels and Outlets.
9. Control Pollutants.
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10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
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11. Main in Best Management Practices(BMPs).
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12. Manage the Project.
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
Ga Gt.f `5 �c...4� 1-1-1u.- 71,•..r l Dro Jo P7viICU-1-.
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3. Environmentally Sensitive Areas.
a. Description of environmentally sensitivg areas that are on r adjacent to the site.
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stormwater site plan template—rev.10/1/2003
9
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b. Description of special requirements for working in or near environmentally sensi've areas.
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4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils e.g.,erodibili ,settleability,permeability,depth,texture,soil structure). 4- Cjl t_T �
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Its►02 uW1 1400A'l ,
5. Construction Phasing.
a. Construction sequence t w �
.6-C►AJ*1 Pim,- - Cc�.GecJ114- tower 1-'°
b e .
b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. ide aLroposed construction schedule.
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II. Wet Season Construction Activities.
a. Proposed wet season construction activities.No f � kQ,t�, .,
Wi t\�v 1-- s'p `-r �l oor✓rs iG�"r
b. Proposed wet season construction activities for environmentally sensitive areas.
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7. Financial/Ownership Responsibilities.
a. Identify
d n�the r 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
imps V
W
8. Engineering Calculations. Provide Design alculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps. `'
b. Diversions. N
c. Waterways.
d. Runoff/Stormwater Detention Calculations � `� s 4)i
10
stammerer site plan template-rev.1 O'12003
NZi:KO COUNTY in-
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 signi , the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct the •= t of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
/ ,l4. ; 0,4_` 7 0-- be
1` (DATE)
OR AUTHORIZED REPRESENTATIVE SIGNATURE) ( )
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
12
stommwater site plan template—rev.10/12003
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