HomeMy WebLinkAboutBLD2006-00115 • • MLA06-00116
Review Type: I
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00115 Received Date: 3/15/2006
SITE ADDRESS: 1779 CAPE GEORGE RD
PORT TOWNSEND, 98368
APPLICANT: DOROTHY T FRANK TRUSTEE PHONE: 360-385-0333
DOROTHY FRANK REV TRUST
42 ALDERWOOD PL
PORT TOWNSEND WA 983689512
SUBDIVISION: LYMAN SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 001074009 Section: 7 Township: 30 N Range: 01 W
CONTRACTOR/ GOLDEN HOMES OF POULSBO PHONE: (360) 697-3456
DEALER: 19647 VIKING AVE NW
POULSBO WA 98370
Contractor's License WAINS 0353 Expires
INSTALLER: GOLDEN HOMES OF POULSBO WAINS 0353 (360) 697-3456
19647 VIKING AVE NW POULSBO WA 98370
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION: NEW MFH
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: SILVERCREST SETBACK:
VALUATION YEAR: 2006
LABOR & INDUSTRIES APPROVAL?
SIZE: 66X39 BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: CAPE GEO
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 3 Prop: 2
Total: 3 Total: 2
Routing Date:
io1.- 0c6
AP '
ED
Type Amount Paid By: Date: Receipt: A�u'oved/DateN
Permit $163.00 LYK 03/15/06 80854 APR oil 2006
Add. Manufactured Home $34.00 LYK 03/15/06 80854
Potable Water Application $55.00 LYK 03/15/06 80854 Jefferson County Planning
C & Building pepartm t
Total: $252.00 �¢-'�
• I
MANUFACTURED/MOBILE HOME INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
360 379-4450 FAX 360)379-4451
PERMIT#: BLD06-00115
SITE ADDRESS: 1779 CAPE GEORGE RD Received Date: 3/15/2006
Issue Date: 4/27/2006
PORT TOWNSEND, 98368
APPLICANT: DOROTHY T FRANK TRUSTEE
DOROTHY FRANK REV TRUST ��
42 ALDERWOOD PL ��� 32`
PORT TOWNSEND WA 983689512
SUBDIVISION: LYMAN SHORT PLAT
PARCEL#: Block: Lot: 1+
001074009 Section: 7 Township: 30 N Range: 01 W
CONTRACTOR/ GOLDEN HOMES OF POULSBO
DEALER 19647 VIKING AVE NW PHONE: (360) 697-3456
POULSBO WA 98370
INSTALLER: GOLDEN HOMES OF POUL
19647 VIKING AVE NW POULSBO WA 98370 Expires:
PROJECT DESCRIPTION: NEW MFH
MAKE: SILVERCREST
YEAR: 2006
SIZE: 66X39
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 4/27/2007.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED):
D6
Stormwater FINAL Approval:
Blocking/Plumbing: 6 -D6
Propane Tank/Lines
Zoning Final Approval: -
Septic System Final Approval (If not on sewer):
Road Approach Final Approval: l•
Final/Skirting/Vents/Porches/Steps: 7 0
HEALTH DEPARTMENT AND PUB C WORKS APPROVAL REQUIRED PRIOR
TO FINAL
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED INSPECTION
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTION
Office Hours 9:00 a.m. -4:30 p.m. S.
HOT-LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY- SEE REVERSE
• I
SPECIAL CONDITIONS CASE # BLD06-00115
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on March 29, 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 and an investigative site
inspection, the following ESAs were confirmed to be present on the subject property:
SUSC aquifer recharge area.
2.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological
formations that allow percolation of the surface water into the soils and 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 7300 square feet of impervious surface and
6000 square feet of land disturbing activities.
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 Stowmater Site 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 revised site plan dated April 18, 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 April 27, 2006 shall be resubmitted for review and approval by Jefferson
County Department of Community Development.
10.) This approval is for a Manufactured home installation 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.
A
•
15.) Exterior lighting for residential es •shall not exceed twenty •
ie
finished grade, excepting when such lighting is an integral part ofabuildingght or strom cture.
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.) Minimum setback from private ingress/egress easement right-of-way shall be 20 feet.
Minimum side and rear yard setbacks shall be 5 feet.
18.) A minimum of two (2) on-site parking spaces shall be provided for the manufactured
home.
19.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive
Land Use Map effective August 28, 1998.
20.) An address of 1779 Cape George Road, Port Townsend has been assigned to the parcel.
Cape George Road is a county Minor collector(C622808). The lot is accessed via a
private easement off of Cape George Road that was established at time of short platting.
21.) A well review (USR06-00003) was approved on January 26, 2006 A septic permit
(SEP05-0347) was approved on December 5, 2005.
22.) Potable water is provided by an individual on-site well.
JACK WESTERMAN.I Jcfiersollunty Courthouse
ASSESSOR PO Box 1220, Port Townsend, U'.% 98368
(360) 385-910
MOBILE HOME INFORMATION FORM
OWNER'S NAME/MAILING ADDRESS:
NAME: b Q ) .� ?1 --
ADDRESS: lc t�v C�' ‘..V too 0 b —T't7tc-xi ?')4
PHONE NO. o b`a - 0 5 /a g:%c
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.
1)MOBILE HOME DATA:
(A) MAKE l/�+ G V e_`a 1 (B) MODEL ) 4- (C) YEAR GU G
(D) LENGTH CO LP (E)WIDTH 3 4 I ( O (F) SERIAL #
t l
(G)YOUR PURCHASE PRICE (Do not include sales tax)l 3 j 5 e . PURCHASE DATE 0141 a c
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE a� p #g
ADDRESS
(B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? Yes No
If Yes, Previous address of mobile.
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 t No
(B)IF LOCATED IN MOBILE HOME PARK:
NAME & ADDRESS OF PARK Lot/Space #
(C) IF NOT LOCATED IN MOBIOME PARK:
NAME OF LAND OWNER:
LOCATION ADDRESS 1 7 7 I C Yam►'n C 6e, 2c -
REAL PROPERTY PARCEL #/DESCRIPTION 0-0 ( 0 1 '4- oo 5.
gnat applicant- l i
THANK YOU FOR YOUR HELP!
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JO COSSELL, Property Technician �'�
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.�ON C � [ ��'�
��, JEFFERA COUNTY 1, ,��_ %! "T,t
DEPARTMENT OF COMMUif
NITY DEVELOPMENT
` `� 621 Sheridan Street • Port Townsend •Washington 98368r
360/379-4450 • 360/379-4451 Fax
.q ��O www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: 06- ])6
Project Description(include separate sheets as necessary : '
—�n 5 .4//,v w o-1 An r, t�b/!7e
Tax Parcel Number. 1 0 c C ' Property }
`r / Size: I f}-c_/`-L-E'_ (acres/square f
Site Address and/or Directions to Property: Lb r ( C A1PU Cep'r.`` e_ 124) . .1771 C �e-Gr-e Rio
Property Owner(s)of Record: Doa-c'>�1-I,,, �'�ay- '� 0
Telephone: 10— 3 — , 3?,.,- Fax:
� email:
Mailin Address: �i 6- q s _3�,.c
g �" �C•��-per i-t�tr%r,-icJl, '�� �C!%t�--� C7�..(��:v`S�'_, '
Applicant/Agent(if different from owner): (2,) I t4 Rot,.cr-
Telephone7.3(c6 (L;q j _ '3 L.S -. Fax3LZ) — G 1 ^ cf'1- C L% email:
Mailing Address: r cl L., (--( �1 V r > I A-u f i) (. • P wi ,t 0 1 L-'(4 / S' -)- ) C
What kind of Permit?(Check each box that applies)
0 Building 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]**
❑ Single Family 0 Discretionary"D"or Unnamed Use Classification
❑ Garage Attached I Detached 0 Special Use(Essential Public Facilities)**
Manufactured Home 0 Boundary Line Adjustment
❑ Modular 0 Short Plat**
❑ Commercial* 0 Binding Site Plan**
❑ Change of Use 0 Long Plat**
❑Address 0 Road Approach 0 Planned Rural Residential Development(PRRD)/Amendment:
W Propane 0 Plat Vacation/Alteration**
❑ Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management 0 Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance
❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District-Map Amendmen
❑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 d ([r
Ji,r to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE) �___
Date: / v 6
Bysigning
ig ing this application form,t er/agent attests that the information provided herein,and in any attachments,is true and correct to the best
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
result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attomey's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of applicati
review and a equi inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
Signet ' // O�
Date: 3f �`
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 Acts or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this pe
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 actin
even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-
transferable r n ibif adhering to and complying with the ESA. The Applicant has read this disclaimer,nd ' ns nd dates it below.
Signature:
Date: i S d
G:\PeanitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
• 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 assu ing t sponsibility of the General Contractor for the proposed project.
Signature: Date: Wi? 6GENERAL CONTRACTOR OR MANU�FAACTUR4ffl/
E INSTALLER: PHONE: FAX:
"(V'vLS'Drni ' ' cs ,I �040‘,� (F 3 477d3‘15-t ( 5kP•b�7- %g
MAILING ADDRESS: i 14-1 v j kw Cji ,A-NA::. QC�tA l 9O EMAIL: b
CONTRACTOR'S LICENSE J WAINS
NUMBER: (r-6 L Pe, Ot P 15-63A p, NUMBER `f 3
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
kfrslew , l-Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: 1., Bank Height ❑Qbmmunity System
❑ Total: aL-
Alteration/Remodel 0 Concrete �� Individual System
❑ Repair ❑ Masonry SEP P rmit# '"^r 47
❑ Demolition 0 Other: Bedrooms: WWr Supply:
Existing: Setback: Private well ❑ Two Pa
Type of Heat: Proposed: 3 ❑ Public
� - Total: j i,A Name of System:
L(a`-T
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: A/l�- Proposed: Z Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed :L. '
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 0 Above ground Tank Size of Propane Tank: _ /2-0
0 Heat Stove 0 Cook Stove 0 Woodstove 0 Fireplace Insert 0 Hot Water Tank 0 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 proper
lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components
includin• the reserve area.
R-Ti. .
Square Footage Current Propoaed :: c,.r%k '-7.It
Main Floor Heated; .. J ;Ti,,,s . , . t EH Bid App Review:
2 Floor Heated f. Consistency Review:
i� i5.3 fix)
Other Heated a Base fee:
Mezzanine `�' , Additional Section:
•� - 4. Cd
, , 9 ,.
Heated Basement ,,,k ' t- ' bLo iPyt; iz- 51 J4D
4
lf
Unheated Basement -`"7� _ I State Surcharge fee:
__._
Other Unheated :t ' -. Pot Water Review fee:
z ,. ; 1 c1U. CX.)
r °
tgoi
Garage/Carport SUBTOTAL
,- 44 - 6..E,Q0
Decks f `. •11/Rd Approach fee: -
.
Other r � -, TOTAL: $ 5 ,
s:Y- Receipt Number: G 51 1
Cash/Check Number: 950
ESTIMATED COST(REQUIRED) Date: 6115
� 'J I
.Fair market value of all labor and materials foundation to finish L)
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Initials:
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
• •
. SON C ( ' I ,ii ' {' ; t)
serf I I I I g $40 ,1 lil, JEFFERSON COUNTY t_
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street - Port Townsend •Washington 98368
O 360/379-4450 • 360/379-4451 Fax
ENO http://www.co.Jefferson.wa.us/commdevelopment/ :, `�J„ `i'i F
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# 0 w A\Q PROJECT/APPLICANT NAME: �.�(i _.c}1 - - 1 "2 'L
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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.
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-Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
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3. ,p escribe the existing vegetation. Indicate native vegetation areas on the site map. J %
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4. Describe the existing soils. Indicate soil type on the site map. O QC�
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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 generated by the proposed use or activi�: APPROVED
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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,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.
9. 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. Loc to these facilities on the site plan and differentiate proposedfacilities 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.]
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11. Describe the performance goals and standards applicable to the project.
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12. Describe the flow control system.
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stormwater site plan template—rev.10/1/2003 6
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13. Describe the water quality system.
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14. Describe the conveyance system analysis and design.
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15. Describe the source of fill material,physical characteristics of fill material, and deposition of excess material.
Said,Ric , coil
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
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17. Describe the proposed surfacing material.
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18. Describe methods for restoration of the site.
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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 included,list the Manuals
her .
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
N�/�
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.
NIA-
stormwater site plan template—rev.10/1/2003
7
• •
CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP)
The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the
template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for
preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater
Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential
development.
SECTION I—CONSTRUCTION SWPPP NARRATIVE
1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or
will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable
to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page
2-15).
12 Required Elements—Construction SWPPP
1. Mark Clearing Limits.
2. Establish Construction Access.
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3. Control Flow Rates. Q
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4. Install Sediment Controls.
-
5. Stabilize Soils.
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6. Protect Slopes.
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7. Protect Drain Inlets.
stormwater site plan template—rev.10/1/2003 8
• •
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
9. Control Pollutants.
11,114
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
11. Maintain Best Management Practices(BMPs).
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).
/4/4
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
Jti 774_
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
1\ I ,4,
stormwater site plan template—rev.10/1/2003
9
• .
b. Description of special requirements for working in or near environmentally sensitive 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.,erodibility,settleability,permeability,depth,texture,soil structure).
l‘/714--
5. Construction Phasing.
a. Construction sequence
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b. Construction pha ing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule.
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II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
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b. Proposed wet seaA on construction activities for environmentally sensitive areas.
47/
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps.
b. Diversions. �///7 /.
c. Waterways. V /
d. Runoff/Stormwater Detention Calculations
stormwater site plan template—rev.10/1/2003 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 Const ction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best my knowledge. I also certify that this application is being made with the full knowledge and consent of all
own o the affec d property.eps
2 /1C {
(LANDOWNER R AJTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
stormwater site plan template—rev.10/1/2003 12
• •
RETURN ADDRESS •
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P , (D. tik»c � ►
?oc-V M IPS , IJA gfn31n"a 67 5Ar,.A2 PT
A-t1'. LA
t A orW FDNG Gf -MANUFACTURED HOME rowsl- -rt�:z•�►Tri
®TITLE ELIMINATION
liCEnsinG APPLICATION JTRANSFER IN LOCATION
Anyone who knowingly makes a false statement of a material fact is guilty
FROM REAL PROPERTY
of a felony, and upon conviction may be punished by a fine,imprisonment,or both.(RCW 46.12.210)
® MANUFACTURED HOME
TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN)
2006 Silvercrest 66 X 39 I'? 3 ' ' 1 S i
® LAND LEGAL DESCRIPTION ON PAGE 2
REAL PROPERTY TA(PARCEL NUMBER
MANUFACTURED HOME WILL BE 11 AFFIXED El REMOVED 001 074 009
LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION
1 LYMAN SHORT PLAT 1/89-7-30-1 W SW SE
® GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS
16 1 1
NAME OF REGISTERED OWNER DCL CUSTOMER ACCOUNT NUMBER
DOROTHY TYRA FRANK
NAME OF ADDITIONAL REGISTERED OWNER DCL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
1633 WATER ST#10 PORT TOWNSEND WA 98368
NAME OF I_EGAI.OWNER DOL.CUSTOMER ACCOUNT NUMBER
FIRST FEDERAL SAVINGS AND LOAN ASSOCIATION
NAME OF ADDITIONAL LEGAL OWNER DCL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
P 0 BOX 351 PORT ANGELES WA 98362
GRANTEE
NAME (------
I DO SOLEM LY ATTEST UN R PEN LTY OF R URY THAT I/WE AM/ R A E THE REGISTERED OWNER(S)OF THIS
VEHICLE AND THIS INFOR ION I CCURATE: ���
Signature of Registered Owner and Title, IF APPLICABLE. �eito. �411
Signature of Additional Registered Owner and Title,IF APPLICABLE.
NOTARY SEA�s I NOTARIZATION/CERTIFICATION FOR REGIS ERED OWNER(S)SIGNATURE
. ....�`....,, tate of Washington 1 ^ �J J Signed or attested C./9 1 01
yilwayip County of J C before me on
(�
3 it a 'ails E yT.„ T S1A r+�- Signature //
RINT NAME OF REGISTERED OWNER NOTA A E.T
0 7 � • . i per-
•; `1•• `PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
'i� W I' ,e\ t• LOn.� Q �' County/Office No.OR a J 1'a,
,,,� TAT '•O� \IIitle Z�-�'A" AND: Dealer No.OR
I0,r,� I E L,,,+`\\\ f DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date a oo
D TITLE COMPX J CERTIFICATION
I certify that the legal description of the land and ownership is true and correct per the real property records.
NAME(TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER
SIGNATURE/POSITION
DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
0 BUILDING PERMIT OFFICE CERTIFICATION
I certify that: 1111 the manufactured home has been affixed to the real property as described.
El a building permit has been issued for this purpose and the attachment will be inspected upon completion.
NAME TYPED OR PRINTED) BLDG PERMIT OFFICE/?HONE# BLDG PERMIT#
141 12., ► h,rL£ Sk.1 K 0,-dr (c)>> 1 q— LILA 5d 06 — coo 1/S
SIGN LURE lPOSIT! L
C 11i ' ' citi A ,
A _ U
TD-420-72 MANUFHOMEAPPL(R/2, ) R P of 2 R�
i-.. .a i. ...VS/. a.i.z. aAaaa vvv -ay. -a a £. n✓a a a.1u uvtaa. vuaS♦ 1.4fj ova
III
111111
MANUFACTURED HOME - FROM SECTION 1
TPO(PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN)
2006 Silvercrest 66 X 39 I —7 -3 ) 1 q 5 g
D SIGNATURE OF LEGAL OWNER -
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELI NATION OF TITL /REMOVAL OM REAL PROPERTY.
Signature of Legal Owner and Title, IF APPLICABLE � — ,, t'jr� a-,Ii
Signature of Additional Legal Owner and Title,IF APPLICABLE /'
NOT�°�miltitiniti i P I NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S)SIGNATURE
�0.LER f�/4 I State of Washington ) ) Signed or attested /� D7
� 'BY O to�I County of L /a i/Q/k1 g before me on /
E a • Z,ohNti . ) Z a v I rP��GALrG 0 NE t,1ln�s Signature R ENT e�f/�it/
PRINT NAME OF LEGAL OWNER
NOT•RY OR ENT
% Q�0 :y bY7 2 rzn , Li) C/jar Amy :Keller
-.-..«...•. P ; RINT NAME dF L OWNER PRINTED NAME OF NOTARY
County/Office No.OR
/l�sTgT E O�,\`\``♦ I Title DE LERSHI POSITIOW ENTINOTARY AND: Dealer No.OR 0/4;0
////f LLt Im Notary Expiration Date
D LAND Dg ChIPTION (A legal description of the land can be obtained from the local County Assessor's Office
LOT I,LYMAN SHORT PLAT,ACCORDING TO THE PLAT THEREOF FILED IN VOLUME I OF SHORT
PLATS AT PAGE 89,RECORDS OF JEFFERSON COUNTY,WASHINGTON.
SITUATE IN THE COUNTY OF JEFFERSON,STATE OF WASHINGTON.
till- DEALER'S REPORT OF SALE
I CERTIFY THAT THIS INFORMATION IS CORRECT.THE VEHICLE IS CLEAR OF ENCUMBRANCES EXCEPT AS SHOWN.
ANY REQUIRED SALES TAX HAS BEEN COLLECTED.
DEALER NAME(TYPED OR PRINTED) WA DEALER NUMBER 'DATE OF SAL
a\Ciean ttvmQs O Thu—S 7O &OLD%q CO143 -t 5 i IA i 0 ip -
PURCHASE PRICE TAX JURISDICTION/TAX RATE DEALER'S AUT ATUR
1'11112.00 8• CO OI 1l
0 USE TAX EXEMPT Sale to a Certified Tribal member i tb reservation(attach notarized statement of delivery).
0 COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents)
I certify that the above application appears to have been completed correctly,and the applicant has sufficient documentation to proceed
with the recording of this form.
NAME(TYPED OR PRINTED) COUNTY OFFICENFS OPERATOR NUMBER
SIGNATURE DATE
10 TITLE FEES
FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX SUBAGENT FEES
TOTAL FEES S TAX
IMPORTANT: Once the application has been approved by the County Auditor/Vehicle
Licensing Office, take your application form to the County Recording Office.
Retain proof of the recording fees paid. If the Recording Office retains
your original application form, obtain a certified copy of the recorded form.
APPLICANTS: Once recorded,you must return to a Vehicle Licensing office to file the
Manufactured Home Application, paying all required fees.Vehicle
licensing subagents charge a service fee.
For full instructions on completing this form for Title Elimination, Removal from Real Property or
Transfer in Location, see form TD-420-730, Manufactured Home Application Instructions.
The Department of Licensing has a policy of providing equal access to its services.
If you need special accommodation,please cal(360)902-3600 or TTY(360)664-8885.
TD-420-729 MANUF HOME APPL(R/2/02)OR(W)Page 2 of 2