HomeMy WebLinkAboutBLD2006-00031 MANUFAt;TURED/MpgILE
Jefferson County Departme�HOME
tOof M omNSTALLATION PERMIT
621 Sheridan Street, Port Townsend, WAS Development
360 379-4450 FAX 360 379-4451
PERMIT#: BLD06-00031
SITE ADDRESS: 360A SANDY SHORE RD
Received Date:
CHIMACUM, 98325 Issue Date: 1/25/2006
APPLICANT: MICHAEL HANNIGAN 2/16/2006
PO BOX 523
CHIMACUM WA 983250523
SUBDIVISION:
PARCEL #: 801103006 Block:
Section: 10 Township: Lot: T 12+
CONTRACTOR/ 28 N Range: 01 �/�/
DEALER
INSTALLER: JAIME KOZELISKI
Expires:
1112 JACOB MILLER RD PORT TOWNSED WA 98368
PROJECT DESCRIPTION: NEW MANUFACTURED HOME (ADU)
MAKE: FLEETWOOD YEAR: 1996
SIZE: 44X25
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED IM
THE EXPIRATION DATE IS 2/16/2007. THIN THAT YEAR.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): 6-E75AtKS
Stormwater FINAL Approval:
Blocking/Plumbing: Lo . w
E 0w4), 1174 0010ia�C d
Propane Tank/Lines 3z$
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval:
Final/Skirting/Vents/Porches/Steps:
904
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 S Office Hours 9:00 a.m. - CHEDULE INSPECTIONS.
p.m.
HOT-LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY- SEE REVERSE
i
MLA06-00025
Review Type: I
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00031 Received Date: 1/25/2006
SITE ADDRESS: 360A SANDY SHORE RD
CHIMACUM, 98325
j/+
APPLICANT: MICHAEL HANNIGAN PHONE: 360-732-410
PO BOX 523
CHIMACUM WA 983250523
SUBDIVISION: Block: Lot: T 12+
PARCEL NUMBER: 801103006 Section: 10 Township: 28 N Range: 01 W
CONTRACTOR/ JAIME KOZELISKI PHONE: (360)385-3215
DEALER: 1112 JACOB MILLER RD
PORT TOWNSED WA 98368
Contractor's License WAINS0626 Expires
INSTALLER: JAIME KOZELISKI WAINS0626 (360)385-3215
1112 JACOB MILLER RD PORT TOWNSED WA 98368
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION: NEW MFH
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: FLEETWOOD SETBACK:
VALUATION YEAR: 1996
LABOR & INDUSTRIES APPROVAL?
SIZE: 44X25 BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 3 Prop: 2
Total: 3 Total: 2
Routing Date:
5Lc 2LQIC);'
TypeApproved/Date
yp Amount Paid By: Date: Receipt:
Permit $167.50 LYK 01/25/06 79026 FEB J(0 2006
Potable Water Application $55.00 LYK 01/25/06 79026
Total:
$222.50 Jefferson County Planning
��, 7anment
JACK WESTERMAN II Jefferson Cola Courthouse
ASSESSOR Po Box It'll/. Fort Townsend, WA 98368
(360) 385-9105
MOBILE HOME INFORMATION FOM P
OWNER'S NAME/MAILING ADDRESS:
NAME: M icfiG ek .) . G tl cotAm
ADDRESS: P-L>. Bo) L-r. i.EYYi -LL:n \ L.06 CjQ 3
PHONE NO. <3Cc;1'>.-'T_�� -t f l 744
The purpose of this questionnaire is to obtain information regarding either the
current location of a mobile home or the previous ownership and location of a mobile
home. This will help our office determine whether the mobile home is already on the
tax rolls in Jefferson County or if it has been moved to this county from another area.
l)MOBILE HOME DATA:
(A) MAKE F Ic� �� , (B)MODEL 51(4 SG_, (C)YEAR C1[U
(D)LENGTH 4/7 (E)WIDTH 5' (F) SERIAL # 6 0 1 j
(G)YOUR PURCHASE PRICE (Do not include sales tax)1,/(ani 4 PURCHASE DATI C-J
2)PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE A/ r?'ri a)
ADDRESS J (* J)( p� �J� C �L(Cr /U I,Ur
(B)WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEA ?Yes) No
If Yes, Previous address of mobile. ( ,-3 g(O /e--a •C E t j f, \
If No, What County was Mobile assessed in last year.
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes
(B)IF LOCATED IN MOBILE HOME PARK:
NAME &ADDRESS OF PARK Lot/Space #
(C) IF NOT LOCATED IN MOBILE HOME PARK: ,{
)//
NAME OF LAND OWNER: tit/Cl)a&'-(�I. 17af .r f')
LOCATION ADDRESS 3 6L�/� /Sa/' y,97[`re, Y `� n y1 c i 61'11, (II
REAL PROPERTY ?ARCEL-#/DESCR ON 10 T R.zU(,/
JA
Signature of ai want
THANK YOU FOR YOUR HELP!
01)„-Q
JO COSSELL, Property Technician
S
HANNIGAN STORMWATER SITE PLAN SUBMITTAL AfilitiOVED
JEFFERSON COUNTY STORMWATER PLAN
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend • Washington 98368 360/379-4450 . 360/3 -44. IEra 5
bury,\VN\ CO elIC1 4011 at LI C:011 M&\1/4 1(1):PCtli, 2006JEFFE•S•NCO TY
DEPT OF( 0 T A I , Id PMENT
MLA: MLA06-00025 SIGNATURE:j 7 f .0%
CASE: BLD06-0031 APPLICANT NAME: Michael Hannigan
PARCEL NO.: 801103006 LEGAL: Tax 12, Less ROW Sec. 10, Twp. 28N, R 1 W
Where the question calls for depiction on a site map, the applicant chooses to either incorporate the
elements into the general plot plan for the Master Land Use Application or to submit a separate storm
water 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.
The site is an approximately 4.9 acre parcel. The proposed improvement consists of the placement of
a manufactured double-wide single-family residence of 1,100 square feet, develop a septic tank,
drainfield and associated development, which will comprise approximately 1,450 square feet, and the
driveway serving the residence will comprise approximately 6,280 square feet[14 x 420J.
The proposed impervious surface falls within the 2,000 to 4,999 square foot of impervious surface
requirements under the Washington State Stormwater Management Manual for Western Washington
as a "Medium"project
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
The site is predominately cleared with essentially gentle sloping landscape, with evergreen forested
area on the west. The property slope totals less than ten foot elevation change from the south
property line to the north.
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
The site is predominately first and second-order growth. Third-order growth exists in the form of
mature evergreen and deciduous trees on the west side of the property.
4. Describe the existing soils. Indicate soil type on the site map.
The existing soils consist of the Alderwood [AICJ series of nearly level to rolling soil on glacial
terraces.
5. Describe the existing site hydrology(i.e., drainage; behavior of water on the site above,below, and
on the ground). Indicate existing storm water 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.
This soil is described as moderately well drained. Runoff is slow to medium, and the hazard of water
erosion is slight to moderate. Surface water collects on top of the soil surface from south to north
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mid-property during the most wet period of the year, gravitating to a natural linear ground
depression.
6. Describe any excess levels of noise generated by the proposed use or activity:
The proposal is for a single-family residence and only the typical accessory uses associated
therewith. This property is a large parcel, which inherently provides large property setbacks.
Coupled with the lack of populated properties in the area, excess noise is not a factor.
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.
None have been determined for this site. The natural land drainage depression is not a wetland, but
is only seasonal.
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.).
Adjacent properties consist of forest and pasture land, which would allow for single-family
residential uses, on large-lot land bases. Larson Lake right-of-way is a paved [light bituminous
treatment]road surface, which provides the traditional power utility corridor.
Permanent Storm water Control Plan
This portion of the Storm water Site Plan consists of the selection and installation of the appropriate storm
water control BMP's 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. Please see application submittals for
these calculations.
9. Describe the developed site hydrology, as proposed. Indicate whether storm water will be fully
dispersed (i.e., per BMP 15.30 in the Manual) or, if not, what types of storm water 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.
The placement of the residence will provide channeled roof flow via downspouts to direct flows to the
surface grassed areas for transpo-evaporation, and natural drainage and infiltration to the existing
ground depression that runs south to north at the mid-point of the property. Road way surface grade
will direct water to the downhill side [north] of the proposed roadway to achieve the same effect,
where bio filtration will take place of surface water. The roadway will be fitted with a large culvert to
allow normal drainage from off-site south to continue on a normal path through the subject property
for the short wet period of surface water collection.
10. If the project requires the use of storm water treatment facilities, describe the types of storm water
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.]
No storm water treatment is necessary for this project.
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1 I. Describe the performance goals and standards applicable to the project.
All storm water is controlled so as to not create erosion or off-site migration.
12. Describe the flow control system.
The placement of the residence will provide channeled roof flow via downspouts to direct flows to the
surface grassed areas for transpo-evaporation, and natural infiltration. Road way surface grades
will direct water to the downhill[north] side of the driveway to achieve the same effect. None will
migrate off-site, but rather,follow grade to the center of the subject site.
13. Describe the water quality system.
None is proposed or required of this proposal.
14. Describe the conveyance system analysis and design.
None is proposed due to the low rainfall statistics of the area, and due also to the size of the property,
and also due to the proposed "best management practices".
15. Describe the source of fill material; physical characteristics of fill material, and deposition of excess
material.
House foundation excavation material will be primarily re-deposited around subject residence, and
back-graded to form a slope away from the residence.
Approximately 6,280 square feet of driveway[14 x 420] is to be created, using pit-run glacial gravel
base course, topped with 3/-inch and minus crushed river-run rock or crushed basaltic rock, which
will amount to approximately 50 yards of course material, and some 40 yards of fine material.
16. Proposed methods of placement and compaction consistent with the applicable standards in the
International Building Code,2003 Edition.
Heavy machinery use will provide primary compaction.
17. Describe the proposed surfacing material.
Yard area around the house will be seeded with grass and contain traditional landscaping plantings.
Approximately 6,280 square feet of driveway[14 x 420]is to be created, using pit-run glacial gravel
base course, topped with 3/4-inch and minus crushed river-run rock or crushed basaltic rock, which
will amount to approximately thirty yards of material.
18. Describe methods for restoration of the site.
None required, as site for residence does not require the removal of trees. The owner may choose to
increase the number of existing trees with additional planting of same. Interrupted field grasses with
be re-seeded to their natural state.
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.
Not applicable for this proposal.
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20. List here and include any special reports or studies conducted to prepare the Storm water Site Plan.
None known by applicant.
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.
Sewage Disposal Permit,Jefferson County
Potable Water Determination
Building Permit, Jefferson County, including addressing and road approach
CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP)
The Construction SWPPP addresses sediment and erosion control during construction. The BMP's
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 Storm water
Pollution Prevention (SWPP)Best Management Practices (BMP's) Packet for guidance, particularly with
rural residential development.
SECTION I-CONSTRUCTION SWPPP NARRATIVE
1. Construction Storm water Pollution Plan Elements. Describe how each of the Construction
SWPPP elements has been or will be addressed. Identify the type and location of BMP's 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).
Required Elements-Construction SWPPP:
A. Mark Clearing Limits.
Minimize limit of land clearing to the residential site only, and marking [flagging] equipment
operation zones.
B. Establish Construction Access.
Via the existing roadway access point to the subject property, construction access will use BMP
C105 "Stabilized construction entrance" to control vehicle and machinery tire displacement of
on-site soils to any off-site roadway. Wash-down of vehicle tires on-site will further control such
occurrence during wet days.
C. Control Flow Rates.
BMP C121 "Mulching" may be implemented to filter any and all downstream water flow, and
thus stabilize the flow rate.
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D. InstaIl Sediment Controls.
While limiting the cleared area for construction, the applicant may install a silt fence at the
natural depression at with the intersection of the proposed driveway, to protect downstream
areas during construction per BMP C233.
E. Stabilize Soils.
The applicant proposes to use BMP C121 "Mulching" to stabilize exposed soils that are subject
to erosion, where applicable along the proposed roadway.
F. Protect Slopes.
The applicant proposes to use "surface roughening"BMP C130 and soil stabilization with BMP
C121 " Mulching" at sloped areas with a ratio of 3:1 horizontal to vertical and greater during
construction, and until new vegetative growth is established.
G. Protect Drain Inlets.
None exist either on or off the subject site. However, a new culvert will be placed under the
proposed roadway at the natural depression, and the openings will be protected with screens and
large rocks.
H. Stabilize Channels and Outlets.
No temporary or permanent on-site channels or ditches exist or are to be created to control
runoff. However, since the proposal consists of a crawl-area grade that is below the finished
grade outside of the foundation, a small channel will be created during construction to allow
drainage of the foundation excavation which will likely require the use of BMP C209 and
mulching BMP C121 until foundation backfill is completed.
I. Control Pollutants.
No vehicle or machinery maintenance is to be allowed on-site over impervious surfaces, and
contractor's equipment will be required to not exhibit hydraulic oil or fuel leakage prior to
storage or use on the site.
J. Control De-Watering (the act of pumping groundwater or storm water away from an active
construction site).
Since the proposal consists of a foundation "crawl" grade that is below the finished grade
outside of the foundation, a small channel will be created during construction to allow drainage
of the foundation excavation which will likely require the use of BMP C209 and mulching BMP
C121 until foundation backfill is completed.
K. Maintain Best Management Practices(BMP's).
The owner or owner representative is to supervise contractors to insure that BMP's are
maintained to their respective functional design.
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L. Manage the Project.
Construction is to be phase to prevent transport of water runoff or sediment, and limiting work
during wet conditions where there may be a negative impact. Coordination of utility work i.e.,
same trench use included, coupled with daily inspection and maintenance of systems is proposed.
2. Adjacent Areas.
A. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes,
wetlands,residential areas,roads).
None to be affected.
B. Description of the downstream drainage path leading from the site to the receiving body of water
(minimum distance of 400 yards).
The proposed project will not result in or create off-site/downstream drainage paths.
3. Environmentally Sensitive Areas.
A. Description of environmentally sensitive areas that are on or adjacent to the site.
None known to applicant. The natural drainage depression is not a wetland.
B. Description of special requirements for working in or near environmentally sensitive areas.
None required at this time.
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, settle ability, permeability, depth, texture, soil
structure).
Analysis of soil characteristics and topography of this site coupled with the proposed project scope
do not indicate any erosion problem potential. The installation of Intercept trench tight-lines are
proposed on the south and east portion of the property, and seaward of the residence location.
5. Construction Phasing.
A. Construction sequence
The applicant is to mark clearing limit area, establish construction access, foundation
excavation, install proposed BMP's per plan, construct project, and then implement the
permanent plan.
B. Construction phasing(if proposed)
Project to be started and completed within four months..
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
A. Provide a proposed construction schedule.
Begin project in winter of 2006, and conclude by Spring of 2006
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B. Wet Season Construction Activities.
I) Proposed wet season construction activities.
None anticipated beyond attempting to keep materials dry.
2) Proposed wet season construction activities for environmentally sensitive areas.
Not applicable for this proposal.
7. Financial/Ownership Responsibilities.
A. Identify the property owner responsible for the initiation of bonds and/or other financial
securities.
The applicant.
B. Describe bonds and/or other evidence of financial responsibility for liability associated with
erosion and sedimentation impacts.
The building permit process and site inspection sequence is conducted by Jefferson County, with
back-up measures by the owner as part of owner's risk management for the project.
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if
applicable.
A. Sediment Ponds/Traps: Not applicable
B. Diversions: Not applicable
C. Waterways: Not applicable
D. Runoff/Stormwater Detention Calculations: Not applicable
SECTION II-EROSION AND SEDIMENT CONTROL PLAN
Sediment and erosion control measures may be depicted on the master land use application plot plan, a
stormwater site plan, and/or a separate Construction SWPPP site plan. This is a checklist to ensure that
the following are depicted on a site plan:
1. General.
a. Vicinity Map
b. Jefferson County Approval Block
c. Erosion and Sediment Control Notes
2. Site Plan.
a. Legal description of subject property,
b. North arrow,
c. Indicate boundaries of existing vegetation(e.g.,tree lines,pasture areas,etc.).
d. Identify and label areas of potential erosion problems,
e. Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable),
f. Show existing and proposed contours,
g. Indicate drainage basins and direction of flow for individual drainage areas,
h. Label final grade contours and identify developed condition drainage basins,
i. Delineate areas that are to be cleared and graded,
j. Show all cut and fill slopes indicating top and bottom of slope catch lines
3. Conveyance Systems.
a. Designate locations for swales, interceptor trenches,or ditches,
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b. Show all temporary and permanent drainage pipes, ditches, or cut-off trenches required for erosion
sediment control,
c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts,
d. Shows grades,dimensions,and direction of flow in all ditches,swales,culverts and pipes,
e. Provide details for bypassing off-site runoff around disturbed areas,
f. Indicate locations and outlets of any dewatering systems.
4. Location of Detention Best Management Practices(BMPs). Identify location of detention BMPs.
5. Erosion and Sediment Control Facilities.
a. Show the locations of sediment trap(s),pond(s),pipes and structures,
b. Dimension pond berm widths and inside and outside pond slopes,
c. Indicate the trap/pond storage required and the depth, length,and width dimensions,
d. Provide typical section views through pond and outlet structure,
e. Provide typical details of gravel cone and standpipe,and/or other filtering devices,
f. Detail stabilization techniques for outlet/inlet,
g. Detail control/restrictor device location and details,
h. Specify mulch and/or recommended cover of berms and slopes,
i. Provide rock specifications and detail for rock check dam(s), if applicable,
j. Specify spacing for rock check dams as required,
k. Provide front and side sections of typical rock check dams.
I. Indicate the locations and provide details and specifications for silt fabric,
m. Locate the construction entrance and provide a detail.
6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be
explained illustrated with detailed drawings.
7. Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of
pollutants other than sediment(e.g.,concrete wash water).
8. Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for
monitoring water quality on the construction site. Sampling stations should be located upstream and
downstream of the project site.
Stormwater Site Plan Changes
Changes or revisions to the originally approved Stormwater Site Plan: any 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 includes 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 o the affected property.
LANDOWNER SIGNATURE &DATE
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SPECIAL CONDITIONS CASE # BLD06-00031 •
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on January 30, 2006 for the potential presence of Environmentally
Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC).
After an initial Geographic Information Systems mapping review, the following ESAs were
confirmed to be present on the subject property: Susceptible Aquifer Recharge Area
(SUSC).
2.) Aquifer Recharge Areas in Jefferson County are characterized by
formations that allow percolation of the surface water into the soils porous
the underlying
zone of saturation. Aquifers are geologic formations that contain sufficient saturated
permeable material to yield significant quantities of water to wells and springs. Aquifers
serve as the source of drinking water within most of the rural portions of Jefferson County.
3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
4.) 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.
5.) The applicant is proposing to create or add 6,100 square feet of impervious surface and
7,260 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson
County Unified Development Code requires that your proposal comply with Minimum
Requirement#2 (Construction Stormwater Pollution Prevention) of the Department of
Ecology Stormwater Management Manual for Western Washington 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.
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 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.) Jefferson County determined that this proposal is categorically exempt from review under
the State Environmental Policy Act(SEPA) pursuant to WAC 197-11-800(1)(b)(i).
9.) The site plan as submitted with the building permit application on January 25, 2006 has
been reviewed for consistency under the UDC, and has been approved by Jefferson
County Department of Community Development. Any modifications, changes, and/or
additions to the stamped, approved site plan dated January 31, 2006 shall be resubmitted
for review and approval by Jefferson County Department of Community Development.
10.) This approval is for a Manufactured Home (ADU) only. Any future permits on this site are
subject to review for consistency with applicable codes and ordinances and does not
preclude review and conditions which may be placed on future permits.
11.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
• •
12.) 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).
13.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
14.) The building height is not to exceed 35 feet.
15.) 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.
16.) 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.
17.) This is a legal non-conforming parcel designated as Rural Residential 1:20 under the
Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998.
18.) A septic permit(SEP05-00384)was approved December 27, 2005 to serve the ADU for a
capacity of 360 gallons per day.
19.) Sandy Shore Rd. (C502909) is a county local access road. A road approach is existing
and an address of 360-A Sandy Shore Rd. has been assigned to the Accessory Dwelling
Unit on this parcel.
20.) A minimum of two (2) on-site parking spaces is required for each single-family residence
on this parcel.
21.) Setback from Sandy Shore Rd. right-of-way is no less than 20 ft., side setbacks are no
less than 5 ft. and rear setback is 100 ft. (adjacent to Rural Forest). If an environmentally
sensitive area (ESA) is present, then the more restrictive setback shall apply.22.) Jefferson County has determined that the use of real property for agriculture and forestry
operations is a high priority and favored use in the county. The county will not consider to
be a nuisance those inconveniences or discomforts arising from such operations, if such
operations are consistent with commonly accepted best management practices in
compliance with local, state, and federal laws. If your real property includes or is within
five hundred (500) feet of real property designated as Rural Residential 1:10 or 1:20,
Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to
inconveniences or discomforts arising from such farming and forestry operations,
including but not limited to noise, tree removal, odors, flies, fumes, dust, smoke, the
operation of farm and forestry machinery during any 24-hour period, the storage and
disposal or manure, and the application of permitted fertilizers and permitted pesticides.
One or more of these inconveniences may occur as a result of agricultural and forestry
operations which are in conformance with existing laws and regulations.
23.) Stormwater shall be retained and infiltrated on site. The owner shall control all
sedimentation and erosion on the property.
24.) Assessor's records indicate an existing main residence approximately 2,400 sq. ft. in size.
This permit is for a manufactured home that is approximately 1,100 sq. ft. in size which
meets the requirements for an accessory dwelling unit (ADU).
25.) MANUFACTURED HOMES INSTALLATION SET UP MANUAL MUST BE ON SITE FOR
ALL INSPECTIONS AND A ADDITIONAL INSTALLATION MANUAL MUST BE
SUBMITTED TO JEFFERSON COUNTY DEPARTMENT OF COMMUNITY
DEVELOPMENT PRIOR TO FINAL
ON • •
S
•� c
w�,�W 06 JEFFERSON COUNTY
f DEPARTMENT OF COMMUNITY DEVELOPMENT
~' ' '� 621 Sheridan Street • Port Townse •Washington:9$368
�. j . . 360/379-4450 • 360/379-4451 Fax, 4_A i, 1 �� Flj
O www.co.efferson.wa.us/commdevel6 ment _ ,; ' :;
'''YhlN0/ j
Master Permit Application JAN 2 5 2005 c-
i
Project Description(include separate sheets as necessary): t
/ t
Tax Parcel J A < i�% �P
PertY
Number: 0 C. I Us 6
o 6 Size: (acres/square feet)
Site Address and/or Directions to Property: - 9 �;�^ j / (, ,#1
Property Owner(s)of Record:
Telephoned 5(r 1 - 73:,G- . /i Fax: email:
Mailing Address: Pt ice, 5 . c6`) r/YtCjC Gt / tc2..-'"c. 513,,
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
f uilding 0 Variance(Minor,Major or Reasonable Economic Use)
0 Demolition Permit ❑ Conditional Use[C(a),C(d),or C]**
❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached 0 Special Use(Essential Public Facilities)**
lnufactured Home 17 Boundary Line Adjustment
❑ Modular 0 Short Plat**
❑Commercial* ❑ Binding Site Plan**
❑Change of Use ❑ Long Plat**
❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
--Prone_ ? 7 7 0 Plat Vacation/Alteration**
❑Allowed"Yes"Use Cons'fstency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance
0 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 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 arse 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.Aers.ss and right of entry to this property shall be requested and shall occur only during regular business
hours. ! . o,
Signature: -- " 17 ( CC 1 Z 2 ram, �s—. `f'
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-transferable9_7 respo `bitty for adhering nd complying with the ESA. The Applicant has read this d' aimer an nss and tes it below.
Signature. _ ' 2' �/ , , Date: f -- C�
t
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
SI 41
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 project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTyRED HOME INSTALLER: PHONE: FAX:
MAILING ADDRESS: (' /7 j�-, "�-c f1 7 /c C EMAIL:
CONTRACTOR'S LICENSE ,!/�l,t J� '/- -1 c.L2 c WAINS
NUMBER: /F�c)/e/fJ cj ,7 7c 3 NUMBER
�GINEER: !) PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
p' New Z Wood Existing: _<¢ ❑ Sewer
D Addition .ei'Steel Proposed: Bank 0 Community System
O Alteration/Remodel ❑ Concrete Total: 9._ Height: ❑ Individual System—
❑ Repair ❑ Masonry SEP Permit#,7 ' ,7 T
O Demolition ❑ Other. Bedrooms: W tpr Supply:OJ38'2/
Existing: P" Setback: Pnvate well ❑ Two Party
T of beat: r Proposed: 7 0 Public
!� I G t r J1 c e. Total: t7 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:
0 Underground Tank 0 Above ground Tank Size of Propane Tank: _
❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove 0 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 R11} sc P, t2LV 10 ,
Current Proposed Amount: d
Main Floor Consistency Review: x -j J Cj
2"t'Floor Base fee: �'� a• 5�'
3f0 Floor .Additional Section: , / '
Mezzanine: ( 1) !_ Plan Check fee:
Heated Basement i"\ State Surcharge fee: . c
JAN 2 5 2006
Unheated Basement Pot°Water' lee ci u 4 0
Other Unheated 91'1/Rd Applilac h fee. Abu- q'1'1 ,0
Garage/Carport
TOTAL: $. 9 ,-j
Decks Receipt Number. r7(11)a
Other C,ashlCheck Number: . c.) "iU it`4 JGD
.
ESTIMATED COST(REQUIRED) Date: -
•
.Fair market value of all labor and materials foundation to finish { j c
Initials:
G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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