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Home My WebLink About06_Permit Application - signed_2023-1030DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port Townsend,WA 98368 Tel:360.379.4450 |Tax:360.379.4451 Web:www.co.jefferson.wa.us/communitydevelopment E-mail:ded@co.jefferson.wa.us 96 & SATTE PERMIT APPLICATION Steps in the Permit Process: -Review application checklist to ensure all information is completed prior to submitting application. -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application;it must be accompanied by a project specific supplemental application. -Fees will be collected at intake.Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Building Permit # Related Application #s MLA # Site Information Assessor Tax Parcel Number:502153020,502153021,502153022,502153023,502154002,502153002,502152005 and 502153003 Site Address and/or Directions to Property:308913 US Highway 101,Brinnon WA 98320-9719 Access (name of street(s))from which access will be gained: US Highway 101 Present use of property:Resort/RV Campground Description of Work (include proposed uses):See Project Narrative. Wastewater -Sewage Disposal This property is served by Port Townsend or Port Ludlow sewer system?YES NO If not served by sewer identified above,identify type of septic system below: Type of Sewage System ServingProperty: Septic Septic Permit +: Community Septic Name of System:Pleasant Harbor Sewer System Case H Are other residences connected to the septic system?No NoAdditionsorrepairstosewagesystem: is it a complete or partial system installation:Complete Partial Has a reserve drainfield been designated?Yes No Date of Last Operations &Maintenance check:N/A Attach last report to application Describe or attach any drainfield easements,covenants or notices on title,which may impact the property: The project will be served by a sewer treatment plant. Permit Application Page 1 of 2 Exhibit 06 The authorized agent/representative is the primary contact for all project-related questions and correspondence.The County will mail /e-mail requests and information about the application to the authorized agent/representative and will copy (cc)the owner noted below.The authorized agent/representative is responsible for communicating the information to all parties involved with the application.It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email (i.e., County email is not blocked or sent to "junk mail"). Applicant/Property Owner Information Property Owner: Name:Pleasant Harbor Marina,Attn:Garth Mann Address:308913 US Highway 101 Phone #:403.256.4151 E-mail Address:garth.mann@statesmengroup.com /Please contact Authorized Agent/Representative with project info.(select only one). Property Owner Signature:Date: Note:For projects with multiple owners,attach a separate sheet with each owner(s)information and signatures. Applicant:Authorized Agent/Representative other than owner] Name:Hatton Godat Pantier,ATTN:Jeff Pantier Address:3910 Martin Way E.,Suite B,Olympia,WA 98506 Phone#:360.943.1599 E-mail Address:jeffp@hattonpantier.com Professional:Is this an Authorized Agent/Representative for this project?NO YES /. Engineer Ÿ Architect Surveyor Contractor Consultant Name:Steve Hatton,P.E.License #24193 Address:3910 Martin Way E.,Suite B,Olympia,WA 98506 Phone #:360.943.1599 E-mail Address:steveh@hattonpantier.com Professional:ls this an Authorized Agent/Representätive for this project?NO YES Y Engineer Architect Surveyor /Contractor Consultant Name:Jeff Pantier,PLS License #28073 Address:3910 Martin Way E.,Suite B,Olympia,WA 98506 Phone #:360.943.1599 E-mail Address:jeffp@hattonpantier.com Professional:Is this an Authorized Agent/Representative for this project?NO YES Engineer Architect Surveyor Contractor Consultant Name:Chris Carlson,AICP License # Address:3910 Martin Way E.,Suite B,Olympia,WA 98506 Phone tt:360.943.1599 E-mail Address:chrisc@hattonpantier.com 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 or her 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 making any issued permit null and void. | further agree to that all activities | intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal,state and county laws and regulations and | agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for sole purpose of application review and any required later inspections.Applicant may request notice of the County's intent to eptêr upon the property for visits related to this application and subsequent permit issuance. Signature:ALY,print Name:M Gar th Mer Date:30 (23 Permit Application Page 2 of 2 Exhibit 06