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BLD2006-00190
9l1ILDING PERMIT APPLICAT•N MRL Review Ty 183 ype Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00190 Received Date: 4/20/2006 SITE ADDRESS: &'; S LYTER AVE PORT TOWNSEND, 98368 OWNER: HOPE INC A WA CORP PHONE: 360-385-5653 JAMES EADES PO BOX 1199 PORT TOWNSEND WA 983680999 IRONDALE SUBDIVISION: Block: 154 Lot: 21-25 PARCEL NUMBER: 962115406 Section: 35 Township: 30 N Range: 01 W CONTRACTOR: HOPE INC PHONE: (360)385-5653 DBA HOPE ROOFING PO BOX 1199/105 LOUISA AVE PORT TOWNSEND WA 98368 Contractor's License HOPER**043N7 Expires 2/16/2007 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NSFR W/ ATT GARAGE & U/G 250 GAL PROP TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,353 VALUATION 320,000.00 ADD'L: 528 HEAT TYPE: PRO CODE EDITION: 2003 HEAT BASE: HEAT TYPE: RAD OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: 440 SHORELINE: CONST TYPE: DECK: 64 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: OTHER BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 3 Total: 3 Total: 3 Routing Date: I (o Type Amount Paid Bv: Date: Receipt: A PPROV EC Permit $2,231.35 LYK 04/20/06 81080 Plan Check $1,405.38 LYK 04/20/06 81080 MAY 2006 State Building Code $4.50 LYK 04/20/06 81080 Potable Water Application $55.00 LYK 04/20/06 81080 Jefferson County P & Building Department Total: $3,696.23 • ` • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-001 90 Received Date 04/20/2006 SITE ADDRESS: 80 S LYTER AVE Issue Date 05/16/2006 PORT TOWNSEND, 98368 APPLICANT: HOPE INC A WA CORP PHONE: 360-385-5653 JAMES EADES PO BOX 1199 PORT TOWNSEND WA 983680999 SUBDIVISION: IRONDALE Block: 154 Lot: 21-25 PARCEL NUMBER: 962115406 Section: 35 Township: 30 N Range: 01 W CONTRACTOR: HOPE INC PHONE: (360)385-5653 DBA HOPE ROOFING PO BOX 1199/105 LOUISA AVE PORT TOWNSEND WA 98368 Contractor's License: HOPER"043N7 Expires: 2H6PJ0 -8456 PROJECT DESCRIPTION: NSFR W/ATT GARAGE & U/G 250 GAL PROP TANK CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: (9d i--,-"Ar.0 4 PP UFFER: fiG I -1� bb rifle Footing: oil, 70 - 4 l'-(3 Foundation: /CevJO (o-�-�sr Stormwater FINALbb Approval: Underground Plumbing: Underground Insulation: Shear Wall : 1e ('Ni CS�Ii-tA.; ex et3v06fr- Sheathing: Framing: /...12--€ Plumbing: - ,ll.his_rg 411/ ,tvr5 . ' */OLP 1,L p .41t,rt) U-Vs I --Propane Tank/ Lines. _r Insulation: A-p 1()/brt�.� aIL ,'m .ZA c;�r ' - O&f t/ 92O6 Sheetrock: 1 Septic Sytem Final Approval MUST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval:<, - Per cc f-eci .i '� 7 01 HEALTH DEPARTMENT A D PUBLIC WORKS A PI4OVAL 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 SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY - SEE REVERSE 4111 SPECIAL CONDITIONS FOR CA• # BLD06-00190 1.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. 2.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ: Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. 3.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ: 1. Installation of a flow meter. 2. On-going well monitoring for chloride concentration. 3. Submittal of monitoring data to County. 4.) MANDATORY MEASURES FOR COASTAL SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirement: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 5.) 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. 6.) A stormwater plan for a medium project 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 subm tted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 7.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 8.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on any lot less than one-half acre unless totally screened from view of neighboring dwellings and rights-of-way. Such screening shall meet all applicable performance and development standards specific to the district in which the storage is kept, and shall be in keeping with the character of the area. Screening shall meet the requirements of Unified Development Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable vehicles is prohibited except in those districts where specified as an automobile wrecking yard or junk (or salvage)yard and allowed as a Permitted Use in Table 3-1 of the UDC, and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area (ESA). 9.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 10.) Minimum setbacks from S Lyter Ave right-of-way, E Cascade Ave right-of-way and S Carnegie Ave right-of-way are 20 ft. Minimum rear setback is 5 ft. 11.) 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. 12.) 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. 13.) The building height is not to exceed 35 feet. 14.) A minimum of two (2) on-site parking spaces are required for the single family residence. I:\F_BLD_Permit_Buildng.rpt 10/29/1999 41,1 I � oN co�� JEFFERSOUNTY Q((� R ) ` DEPARTMENT OF COMMUNITY DEVELOPMENT xiLi ETA`Ty 621 Sheridan Street • Port Townsend •Washington 98368 �t.� 360/379-4450 • 360/379-4451 Fax �1SZrI NC1( 9 www.co.jefferson.wa.us/commdevelopment i `` A �% ty 20i 6 Master Permit Application MLA SOIj ,( .6�,1 g,- Project Description (include se rate sheets ecessary): " k /�_ Property Tax Parcel Number: v" i J S' l; (; Size: / , ,- w (acres/stare feet) : ::: Direcons to Pperty: Qljl� Jmo,of Record: - , ✓ -Jyc . r /71 q1,,� Telephone: '� - u '6 _ Fax:;�7 7Ct - j�s(� email: ` Mailing Address: /43 ) >."1 4 ,,r.,� . ' Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) 4-13'uilding ❑ Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit ,� 0 Conditional Use[C(a), C(d),or C]** M.-Single Family_,_...:-., ❑ Discretionary"D"or Unnamed Use Classification 8-6arag -Attached detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured F1ome ❑ Boundary Line Adjustment ❑ Modular 0 Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use 0 Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ErPropane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance ❑ Temporary Use 0 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 of er local, stat or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate ,,/1,\� to act as my agent in matters relating to thi appli tion for permit(s). OWNER SIGNATURE r\t,.. ....-1 J Date: 1/ 77+ �' Cp By signing this appli ti 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 know! e. 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 access 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.Access and right of entry to this property shall be requested and shall occur only.during regular business hours. ' ( �, Signature: ��l�ii`— ? '� _ _ Date: f / /�3.�0 t. 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- transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and sign and/dates it below. Signature:�.,Jr�, — ' .� - Date: c !,i h G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc 0 • 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 MANUFACTURED HOME INSTALLER: PHONE: FAX: (3k) 3eS ,C&bS (. )) 3 MAILING ADDRE S: 0 6c�`K ) c7c EMAIL: CONTRACTOR'S LICENSE .117�7� ,n �C ^ —� 0 WAINS NUMBER: �� 8,,ce NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage eVlgew Mood Existing: / ❑ Sewer ❑ Addition ❑ Steel Proposed: 2,J.L--- Bank Height: ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: 2.--Ii4.•,... I. ,g'Individual System ❑ Repair ❑ Masonry `:�N SEP Permit# t"- --co, 3 ❑ Demolition ❑ Other: Bedrooms: I Water Supply: Existing: Setback: ❑ private well ❑ Two Party Type of Heat: Proposed: ?, public Total: �� L. ? Name of System: P(-(L) 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: C Underground Tank ❑ Above ground Tank Size of Propane Tank: .` C ❑ Heat Stove I_a--Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet St& e ❑ Other f i 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 Current Proposed For Office Use Only Amount Revision Main Floor Heated E Bld App Review: 1353 1 a1 di. . 3 � .o0 2"°Floor Heated C nsistency Review: �, &, IA-1 DL1tcP4 i ' , op Other Heated Base fee: Mezzanine i.. S -',1 ; 1 L ' 'i Additional Section: Heated Basement ,, Plan Check fee: I. 4 0 c.. . , ., , 1 ©J, 453 Unheated Basement State Surcharge fee: L , )D Other Unheated j I`. Pot Water Review fee: Garage/Carport /�;f`� �O��©t�� SUBTOTAL �U L�� �� `j 1 Decks L 1 „ � 3RdApoV fee: ��.( .ther �j p CO(� TOTAL: $ 4 ' b, d Receipt Number: 2 1 (AD D Cash/Check Number: L qq5 ESTIMATED COST(REQUIRED) Date: •Fair mark value ofBlHabor:pnrtrfinaten cation to finish 41 � 0 (t r1 Initials: G:\Perm nter\FORMS\DRD FORMS\Master Pe ' Application 12-30-05.doc • • Irv . O JEFFERSON COUNTY � 'n ��DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 A 2 2006 360/ "KINO6'O http:/3/www.co.jefferrson wa.s/ommdevelopment/ JEFFERsoNcouNn Cr.O STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# C/(r) l O PROJECT/APPLICANT NAME: �ir�tX Lify�.�— 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. t. / ' �i,Lu . ' iC( -tc c-fr A5=)Z � , t>rk�-C�.. V--LL co, Existing Conditions Summary A' a i�O VED STORMWATER PLAN 2. Describe the existing topography. Indicate contours on the site map. L- OY - 82006 • 3. Describe the existing vegetation. Indicate native vegetation areas on the site ap. JEFFERSON COUNTY �. DEPT.OF c NOUN a 4. Describe the existing soils. Indicate soil type on the site map. t I �� �! c ?2L cS ,_p f 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. 1 .��- `( ,22 r— 4/ ' ,c 4 6. Describe any excess levels of noise generated by the proposed use or activity: l c - t3 G3�c.-� .�- c' � 1�°f��f-.1�.'rrcce <�/24 puts _.4it,Lk_ .. u u ANSONstormwatersiteplantemplate—rev.10/1/2003 COUNTY DCD • • 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. 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.). 91* 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: Locat these facilities on the site plan and differentiate proposed facilities from existing facilities. Ej�c��l►� Ali' 4 Ate, :�c ` ` %' (-12}r-1 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 applicabj9 to the pwject. 12. Describe the flow control system. r k �, APR 2 0 2006 f F stormwater site plan template—rev.10/1/2003 JL I }{`,� r 6 't,J '� �UUNIY OCt� • • 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. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. e - 17. Describe the proposed surfacing material. t- " q % .641 18. Describe methods for restoration of the site. C /2 •�tc� r, 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. 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. 21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or restrictions here. APR 2 0 NW stormwater site plan template—rev.10/1/2003 J E E FE R S U N C U U N FV U C D 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. -.-9-2-'74-'4_-t...../ .„...e '-'z'-7--';/._ ---">27.--ir,,,01-€3.4 Ce;--.e-e'-'-c--1 /27. 2. Establish Construction Access. k)—)i1,1i9 C . ... f�l4 Q tic z �,..a. C,,,?://,- `,l ij .c,44.....44-,o 3. Control F w Rates. Mi C'_ x) f 4. Install Sediment Controls. 5. Stabilize)Soils. 6. Protect Slopes. 7. Protect Drain Inlets. !R JIi tC IF 1`\''Tf— APR 2 0 2006 stonnwater site plan template—rev.10✓1l2003 JEFFERSON I''++,+Oh 8 t+ i l iiLil 1 • • 12 Required Elements-Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 9. Control Pollut ts. ., 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Managemeent//Practices(BMPs). -es21-1, t.".e 12. Managr a,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). b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. f APR 202p03 stormwater site plan template—rev.10/1/2003 9 JfUFE0S0-N COUNTY0C0 • • • b. Description of special requirements for working in or near environmentally sensitive areas. 0 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). C' 5. Construction Phasing. a. Construction sequence 4.�C —4� � ., ' �.,, /,� - I S" .erE0c 42, — .2v eel b. Construction phasi (if proposed) ' 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provi proposed construction schgdule. II. Wet Season Construction Activities. a. Proposed wet season construction activities. b. Proposed wet season construction activities for environmentally sensitive areas. 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. AVA � c. Waterways. R. } �TT a ri p "d. Runoff/Stormwater Detention Calcula21'' V A.' 1 -` ' APR 2 0 2006 stormwater site plan template—rev.10✓1/2003 J E f f E fl 10 SON COONIY DCO • • 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 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 of the affected property. /1/c),,/o „ (IA.DOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: • � lit 1 s D APR 202 stormwater site plan template—rev.10/1/2003 AM.F F .A SI N C i N tY DCD 12 AMMON C:3) t -- ( ..------- 90 C. .... r111....., Lei rrl II CU. CL -..... CD . . , „its, 0 .„vp hoM Ro li Ca - - ' Y7 .1$i FO ta g , . . . IC 1 i • i 4 Al4 • P 0. , . 4W-47 W-2 3/1" f.-49.l' / / 3-3 V2' 3'-0' r 3.-0* 44 W / C • • M 4 A 3040 3040 614 641 \ \ ‘ ‘ ' • • N.• ----11.-----1====7 r 4 ! $ . M i 11 6 I , ..t < , , ; • 5 m is M .... F 2468 'ne --< _.,.— 7asam 11 4 FA 1 -,‘ a q r ; ':!§ 0 t ' (N A 4. 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