HomeMy WebLinkAboutBLD2005-00717 3UILDING PERMIT APPLIC$GN MLA05-00669
Review Type:I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00717 Received Date: 11/15/2005
SITE ADDRESS: 297738 HWY 101
QUILCENE, 98376
OWNER: JACOBA VANDEWEGHE PHONE: 360-379-3609
ROBERTUS VANDEWEGHE
723 DISCOVERY RIDGE RD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot: T 25
PARCEL NUMBER: 702273016 Section: 27 Township: 27 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NSFR W/ATT GARAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 900
VALUATION 212,219.00 ADD'L: 1,288 HEAT TYPE: EEE
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES: 2
OCCUPANCY:
CONST TYPE: 5N OTHER: SHORELINE:
CONST TYPE: GARAGE: 425 SETBACK:
DECK: 216 BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL 1
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 3 Prop: 3
Total: 3 Total: 3
Routing Date: t I (i (os n(23
Type Amount Paid Bv: Date: Receipt: A Approved/Date
Permit $1,626.55 SLE 11/15/05 77418 1
Plan Check $1,057.25 SLE 11/15/05 77418 JAN 5 2006
State Building Code $4.50 SLE 11/15/05 77418
Potable Water Application $53.00 SLE 11/15/05 77418 Jefferson County Planning
,�,��� & Building Department
Total: $2,741.30 Cd"�tle\
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SPECIAL CONDITIONS FOR COIE # BLD05-00717 •
1.) Flood proofing measures are to be used as required by the Jefferson County Flood
Damage Prevention Ordinance for the well and the well house.
2.) All new construction shall use construction methods which minimize flood damage.
3.) All new construction shall: a. be anchored to prevent flotation, collapse, or lateral
movement of the sturcture. b. be constructed with materials and utility equipment resistant
to flood damage and potential damage to adjacent properties. c. be constructed using
methods and practices that minimize flood damage. d. have structural components
capable of resisting hydrostatic and hydrodynamic loads and the effects of buoyancy. e.
electrical, heating, ventilation, plumbing, air-conditioning equipment, and other service
facilities shall be designed and/or otherwise elevated or located so as to prevent water
from entering or accumulating within the components during conditions of flooding.
4.) Utilities shall be designed as specified in Section 5.20 of Ordinance No. 18-1120-95.
5.) The identified Fish and Wildlife Habitat Area (Type 1 Stream), shall maintain a vegetative
buffer setback of 112 feet. The setback shall be measured horizontally from the Ordinary
High Water Mark (OHWM) to the proposed residence and related improvements.
6.) An additional setback of five (5) feet is required from the edge of the buffer area to the
proposed residence and drainfield. This brings the total setback to 117 feet based on the
Habitat Management Plan.
7.) A permanent physical separation along the boundary of the buffer area shall be installed
and permanently maintained. Such separation can include installing logs, trees, a
hedgerow, or any other prominent physical marking approved by the UDC Administrator.
8.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or
every one hundred (100) feet, whichever is less. Signs shall be in place prior to and
during construction activities. The signs shall contain the following statement: "Buffer- Do
Not Remove or Alter Existing Vegetation."
9.) 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.
10.) 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.
11.) A 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.
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.) There is a 117 foot setback from the OHWM, which is the edge of the Big Quilcene River
(reduced by the Habitat Managment Plan). The side and rear setbacks are 5 feet from
property lines.
15.) The applicant shall re-establisl 117 foot area between the residence and f Big
Quilcene River with native trees and shrubs. The area west of the existing road shall not
be mowed or utilized for parking. However, pruning of trees and shrubs is permitted within
this area. The area west of the existing drive shall be designated for river buffer and may
not be utilized for any other purpose authorized by this permit except passive recreation.
The applicant and future landowners are required to comply with the recomendations of
the Habitat Managment Plan prepared for the property. Within one year of the issuance of
the final occupancy permit, a Wetland Biologist shall submit a report indicating whether
the enhancement measures listed within the Habitat Management Plan have meet met.
This will also entail an inspection by the DCD Development Review Section.
I:\F_BLD_Permit_Buildng.rpt 10/29/1999
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702 284 000- Department of Nat Resources
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APPROVED Nov 5 2005 ���sc��%%
SITE PLAN Site Plan: VandeWeghe
297 738 Highway 101 , Quilcene
JAN - 3 2006 Tax number: 702 273 016
''11'�i�� Scale: 1/4" = 20'-0"
JEFFERSSN COUNTY
DEPT.OF COMMUNITY DEVELOPMENT
SIGNATURE:
f t 430'
@ various adjacent residential lots
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residence area to be cleared `'• I
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APPRAPPROVE ,,,,
ATER PLA'ti STORMVCIATER Site Plan: VandeWeghe
S 297 738 Highway 101 , Quilcene
Tax number: 702 273 016
I Scale: 1/4" = 20'-0"
JEFFER r Ce
DEPT.OF cosimt:.11 i
SIGtiATURG ---_
• •
BUILDING
PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00717 Received Date 11/15/2005
SITE ADDRESS: 345 HIDDEN DALE DR Issue Date 01/5/2006
QUILCENE, 98376
APPLICANT: JACOBA VANDEWEGHE PHONE: 360-379-3609
ROBERTUS VANDEWEGHE
723 DISCOVERY RIDGE RD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot: T 25
PARCEL NUMBER: 702273016 Section: 27 Township: 27 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: A new Single Family Residence with an attached garage, and
associated improvements. This proposal is located between an
existing driveway and the Big Quilcene River on the side of a hill.
The Big Quilcene River is a freshwater Shoreline designated
Conservancy and the hillside has a slight landslide hazard. Based
on the conditions of the parcel the applicant is seeking a 25percent
reduction of the shoreline setback from the Big Quilcene River
from 155 to 117 feet& has submitted a Habitat Management Plan
as required by Section 3.6.8 of the UDC. By placing the structure
up the hillside as far as way as feasible from the river, the applicant
has also submitted a geotechnical report to address slope stability
as required by Section 3.6.7 of the UDC. A survey with flood
elevations has also been provided. The requirements for the
reports submitted are found in Section3.6.10 of the UDC.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS: t2k A; .16TSY OWMgo._ .4//0-6A
UFFER: Ok l3/�06�
Footing: ,Oye / 304, nn
Foundation: l Nsr4tu- / ))S r P
Stormwater FINAL Approval: UU
Underground Plumbing:
Underground Insulation: `�
Shear Wall : E ��JC, Wvt.cS�L��vc>-11 >��_ —trM4 4a%4 r ��1�1?frc.t��i—( '� S-VIR Wq%%)
Sheathing:
Framing:0.406CF2.490) i4 6 c -- ci,kt ►,% S--<L 114/ 5
Plumbing: IR-- c-C)lo Ulm GS'
Propane Tank/ Lines: 6
Insulation: S5-6toS/i��(o
Sheetrock:
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: � -Par 2
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVA 1}
REQUIRED P11IOR 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
• OWNER BUILDER STATEMENT •
The signer of this stateme 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 ponsibilI lot/General Contractor for the pr
oposed oposed project. /
Signature: `� Date: (/! cf7�S�
Ali{ 1
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER:— --f-- - PHONE: ! FAX:
) , ( )
MAILING ADDRESS: NOVTI I
CONTRACTOR'Sn,
LICENSE 'n`' WAINS I
NUMBER: - NUMBER i
ARCHITECT/ENGINEER: ! ;, PHONE (_`' ) FAX ( )
MAILING ADDRESS: EMAIL
Prpject Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Lg' New B"Wood Existing: B'gewer
0 Addition ❑ Steel Proposed: 2.S Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: 2.s Height: ❑ Individual System
❑ Repair 0 Masonry SEP Permit# ' 3'3
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: a Setback: if Private well 0 Two Party
Type of Heat: Proposed: 3 ❑ Public
1-62-c }itn L Total: 3 Name of System:
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
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 [1 Above ground Tank Size of Propane Tank:
❑ Heat Stove 0 Cook Stove ❑ Woodstove [1 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
Current Proposed Amount
Main Floor Consistency
Consistency Review:
7"
2NU Floor 1 _ Base fee:
3`tl Floor Additional Section:
Mezzanine: Plan Check fee:
l G 67.,9
Heated Basement State Surcharge fee:
if cg:")
Unheated Basement Pot Water Review'fee: V. •60
Other Unheated 911/Rd Approach fee: �r—.
Garage/6aa�eR"' {, y !X1S7(0 t�
12.E boor t+z( TOTAL: $ Z( 24,• ?O
Decks v
Q. 16 7 i. 17 Receipt Number: i t LV(€,
Other
. ' h/Clheck Number: 9`
VKI
ESTIMATED COST(REQUIRED) Date: !(/(�f` �.
.Fair market vale of all labor and materials foundation to finish
j ow Initials: (��f
1 Ii
G:\PermitCenter\FORMS\DRD FORMS\Master Pemut Application 7-8-04.doc
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,��ggoly co& JEFFERSOISOUNTY +!
#V DEPARTMENT OF COMMUNITY DEVELOPMENT- ' , L I Q/
621 Sheridan Street • Port Townsend •Washington 98368 l J
4, , 360/379-4450 • 360/379-4451 Fax „ i co Altik( U6?.k v -
qs, e www.co.jefferson.wa.us/commdevelopmENOV 1 5 2005 I 4� 1
hTIN i 1 F
Master Permit Application MLA: Q --LTL-----9-----Description(include separate sheets as necessary):'•- G;E.
t akdl_wQ�l� Q ��►,fe—
Tax Parcel 2. 2 1-3 ,. t 6 Property
Number: Size: -3— `x — (acres/square feet)
Site Address and/or Directions to Pro jrty: 1 -I 3? t-t` Lw ay t. i q t,.. t(cR j_ tom)4
C1 Property Owner(s)of Record: '6 3 a LPS (1ckn J& L l ells,—
Telephone: 3 6 at/ 3 6c')- Fax: n email: V cl A d-la c_ TS'c nel .
Mailing Address: 1--2'i ,�};1 'd3Q AA6 4" Tow'r'. WA cyS'J?6g �'~'
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
Mat kind of Permit?(Check each box that applies)
M/Building ❑Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit ❑Conditional Use[C(a),C(d),or C]**
6/Single Family ❑ Discretionary"D"or Unnamed Use Classification
1 6rGarage Attached/-Betachity' ❑ Special Use(Essential Public Facilities)**
❑ Manufactured Home ❑ Boundary Line Adjustment
11 Modular ❑ Short Plat**
11 Commercial* ❑ Binding Site Plan-*
I1 Change of Use ❑ Long Plat**
11 Address LJ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
LI Propane ❑ Plat Vacation/Alteration'`*
ii Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater 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* ❑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:
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 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 a and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required la n ctions.Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
Signature: 7/ (I (Date: �AC
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 n , 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 pliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable re 4bility fora ering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date: t r( Y( o
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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6 JEFFERSON COUNTY
44; DEPARTMENT OF COMMUNITY DEVELOPMENT ...,_____------
4,4, ,1 621 Sheridan Street • Port Townsend • Washington 98368
1s �O 360/379-4450 . 360/379-4451 Fax
�7NC` http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
IMLA# o " b ( PROJECT/APPLICANT NAME: POL OQ^d sL O �
J I
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 Y
1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the
site map. ll__ pp
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Existing Conditions Summary
2. Describe the gxisting topography. Indicate contours on the site map.
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3. Describe the existing ve et tiggn i I
. Indicate native vegetati n areas on the site map.
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4. Describe the existing soils. Indicate soil type on the site ap. �:
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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. /
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6. Describe any excess levels of noise generate =- -/
APPROVED U
,. STORMWATFR PLAN
NOV it 2005
13
JAN - 3 2006 _ t. W,0,
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stormwater site plan template-rev.10/1/2003 -
JEFFERSON COUNTY s
DEPT OF COMMUNITY DEVELOPMENT
SIGNATURE.
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 sensitivefcritical areas
(streams,wetlands, lakes,steep 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.
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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.
NOV 1
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.
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6. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
17. Describe the proposed surfacing material.
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18. Describe Methods for restoration of the site( p -
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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 includedJbst the Manuals
here.
20. List here and include any special reports or studies condu ted to prepare the Stormwater Site Plan.
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—21. List othenecessary 1 t4`ot MG a
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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
0 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.
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a 2. Establish Construction Access.
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3. Control Flow Rates.
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4. Install Sediment Controls.
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5. Stabilize Soils.
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6. Protect Slopes.
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7. Protect Drain Inlets..,�(t}
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8
stormwater site plan template-rev.10/12003
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
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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. Maintain Best Management Practices(BMPs).
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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).
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b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
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3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
- NQy 1 5 2005
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).
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5. Construction Phasing.
a. Construction sequence CQR eCC�
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b. Construction phasing(if proposed) t -� �A►�c /C1
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
Provide a proposed construction sch ule. v 4.� e //
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II. Wet Season Construction Activities.
a. Proposed wet season construction activities. — P &. tt(( �/ln.,.:a .
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b. Proposed wet season construction activities for environmentally sensitive areas.
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7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
7-
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
stormwater site plan template—rev.10//2003 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 SW PPP 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.
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
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l
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1 `s 2005
12
stormwater site plan template—rev.10/1/2003 m