HomeMy WebLinkAboutBLD2006-00507 • • MLA06-00488
Review Type: I
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00507 Received Date: 8/31/2006
SITE ADDRESS: 1074 OAK BAY RD
PORT HADLOCK, 98339
APPLICANT: JOHNEEN V GUSTAV PHONE: 206-935-8744
2562 56TH AVE SW
SEATTLE WA 98116-2220
SUBDIVISION: IRONDALE AC TRACTS Block: Lot: 41+
PARCEL NUMBER: 962700043 Section: 12 Township: 29 N Range: 01 W
CONTRACTOR/ BUY RITE HOMES PHONE: (360)681-0871
DEALER: 3543 W STATE HWY 16
PORT ORCHARD WA 98367
Contractor's License BUYRIH*0840B Expires 05/20/2008
Contractor's License WAINS0250 Expires 07/31/2007
INSTALLER: JAMES HOESEL WAINS0250 7/31/2007 (360)681-0871
641 PARISH RD SEQUIM WA 98382
REPRESENTATIVE: BUY-RITE HOMES PHONE: (360) 681-0777
259403 HWY 101
SEQUIM WA 98382
PROJECT DESCRIPTION: NEW MFH
MODEL : SDLX-40063
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: KARSTEN SETBACK:
VALUATION 67,807.00 YEAR: 2006
LABOR & INDUSTRIES APPROVAL?
SIZE: 48 X 28 BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 2 Prop: 2 ', 1p 2006
Total: 2 Total: 2
Routing Date:
'3 I3116(0 Kr)
Type Amount Paid By: Date: Receipt: Approved/Date
Manufactured Homes $163.00 KAS 08/31/06 84854
Potable Water Application $55.00 KAS 08/31/06 84854
Total: $218.00
• 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 #: BLD06-00507 Received Date: 8/31/2006
SITE ADDRESS: 1074 OAK BAY RD Issue Date: 10/10/2006
PORT HADLOCK, 98339
APPLICANT: JOHNEEN V GUSTAV
2562 56TH AVE SW
SEATTLE WA 98116-2220
SUBDIVISION: IRONDALE AC TRACTS Block: Lot: 41+
PARCEL#: 962700043 Section: 12 Township: 29 N Range: 01 W
CONTRACTOR/ BUY RITE HOMES PHONE: (360)681-0871
DEALER 3543 W STATE HWY 16
PORT ORCHARD WA 98367
Contractor's License BUYRIH*0840B Expires 05/20/2008
INSTALLER: JAMES HOESEL WAINS0250 Expires: 7/31/200;
641 PARISH RD SEQUIM WA 98382
PROJECT DESCRIPTION: NEW MFH
MODEL : SDLX 40063
MAKE: KARSTEN
YEAR: 2006
SIZE: 48 X 28
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 10/10/2007.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
Setba ks/Footing (CONTINUOUS OOT NG, SLAB or PADS USED): 13/7e04Gp'
c�t7uc StAg 4V: 3421
Stormwater FINAL Approval:
Blocking/Plumbing: - Ok //3// ?41'
Propane Tank/Lines
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval:in./Vents/Porches/Steps: 17/74,17
HEALTH DEPARTMENT AND PUBLIC WORKS AOVAL 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
• •
SPECIAL CONDITIONS CASE # BLD06-00507
1.) The application was reviewed by the Jefferson County Department of Community
Development for the presence of Environmentally Sensitive Areas (ESAs). The
Department conducted a review and has concluded that the property DOES NOT contain
Environmentally Sensitive Areas. However, future proposals will be subject to a new ESA
review and conditions may be added if new ESAs are found on the property.
2.) The applicant is proposing to create or add 2904 square feet of impervious surface and
3046 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require 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.
3.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP)
Elements#1 through #12 of the Department of Ecology's 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.
4.) A Stormwater 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.
5.) 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).
6.) The site plan as submitted with the building permit application on August 31, 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 September 26, 2006 shall be
resubmitted for review and approval by Jefferson County Department of Community
Development.
7.) This approval is for a manufactured home 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.
8.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
9.) Not more than 2 unlicensed vehicles shall be stored on any lot 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 Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor
vehicles is prohibited except in those districts where specified as an autormobile wrecking
yard or junk (or salvage)yard and allowed as a permitted use in Table 3-1 or Chapter
18.18 JCC, and such storage shall meet the requriements of JCC 18.20.100, Automobile
wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor
vehicles be stored in a critical area.
10.) Minimum setback from Oak Bay Road right-of-way shall be 30 feet. Minimum setback
from Lincoln Street right-of-way shall be 20 feet. Minimum south and east setbacks shall
be 5 feet.
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.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
15.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
16.) The parcel has been designated as RR 1:5 under the Jefferson County Comprhensive
Land Use Map effective August 28, 1998.
17.) The lot was created through the Irondale Acre Tracts on December 12, 1910 under AFN
31830 and amended on April 8, 1991 under AFN 339373.
18.) The site is served by PUD #1 water.
19.) A septic permit(SEP06-0286) was issued on October 9, 2006. A road approach
(RAP05-0098) was finaled on June 23, 2005.
20.) An address of 1074 Oak Bay Road, Port Hadlock has been assigned to the parcel. Oak
Bay Road is a county major collector(C569908).
JACK %VESTERMAN I Jefferson Clity Courthouse
ASSESSOR 1'O fox 1221Port Townsend, WA 98368
(360) :18 5-9105
MOBILE HOME INFORMATION FORM
OWNER'SNA".ME/MAILING ADDRESS:
NAME:
ADDRESS: :25 4 SG t� &/,�e S Ge) Ns,
PHONE NO. 2d/,, -935--f 71/ /
The purpose of this questionnaire is to obtain information regarding either the
current location of a mobile home or the previous ownershi and cati no mobile
home. This will help our office determine whether the mobi 4,46.0061..44117, on the
tax rolls in Jefferson County or if it has been moved to this county from another area.
AUG 3 120I6
1)MOBILE BOME DATA: [(j('(�ft' I ff'' jj
(A) MAKE �L L_ (B) MODEL 5/24- #E N l:U��i�
,`Q X - 1p J (C) YEAR ZDD
(D) LENGTH 7 O (E) WIDTH
(G) YOUR PURCHASE PRICE (Do not include sales tax) G 7,80 7. °" PURCHASE DATE (9/7/Q(p
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IFF NEW MOVE TO/ QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE " l.Le�-/(�1p. ` 4 - &
ADDRESS .254)V-D,_5 )6tiq /d/ � 2 ��.��� ZC}a 7g,58Z
(B) WAS MOBILE HOME ASSESSM IN JEFFE ON COUNTY LAST YEAR? Yes
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 No
(B)IF LOCATED IN MOBILE HOME PARK:
NAME & ADDRESS OF PARK Lot/Space #
(C) IF NOT LOCATED IN MOBIHOME PAR
NAME OF LAND OWNER: , gi), l Z 47-,
LOCATION ADDRESS /D 7 O(bC / ._,44/.6--t't _ aid 0237
REAL PROPERTY PARCEL #/DESCRIPTION go ?,.,7OO )
gnature of p leant
THANK YOU FOB YOUR HELP!
e53„-e
JO COSSELL, Property Technician
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, ,i)errio�� JEFFER COUNTY 411/
DEPARTMENT OF COMMUNITY DEV•" f MFNT
` `1 621 Sheridan Street • Port Townsend . r$at ingto`n-983b8 i:,
360/379-4450 • 360/379-4451 Fax
\ qS, p' www.co.jefferson.wa.us/commdevelopment,.l
&LIG3x2ja6
Master Permit Application MLA: OG_ LI 8
Project Description (include separate sheets as necessary JEFPERSON COUNTY OD
Property
9 Tax Parcel Number: ' Z 70L:),0 S/✓. Size: /, z//5 4t& J (acres/square feet)
Site Address and/or Directions to Property: /Q 7/ f1a ' x ,�. yk Y e L//eZ 98,5 39
Property Owner(s)of Record: / U 1 /%z4.c.,
Telephone:76(p•435- ?7 V Y /�— Fax: email:
Mailing Address: 75-6 z 56 U!�_ -( ;�k) a j'-7 _ bia, q9//(o
Applicant/Agent(if different from owner): ��a - OrD'iy 4
Telephone: 360 •- 68/-O77 7 Fax: email:
Mailing Address: 2 5 V Ste3 i•P- /d/ ;e2-fete /(i. 9 8Z
Wtl t kind of Permit?(Check each box that applies)l
&uilding ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit 0 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)**
a-nufactured Home ❑ Boundary Line Adjustment
❑ Modular 0 Short Plat**
❑ Commercial* 0 Binding Site Plan **
❑ Change of Use 0 Long Plat**
❑Address ❑ Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments**
❑ Propane 0 Plat Vacation/Alteration**
0 Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
0 Stormwater Management 0 Shoreline Management Substantial Development**
0 Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance
❑ Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 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:
� \ ��`���� E IGNATION OF AGENT
I hereby designate /,/,e -Al-_ )CX.�iiC�J E/� , i _ to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE ti /"jo,Z Date: c 2/ 0
By signing this applicati o ,the owner/agent attests that thehe information provided herein,and in any attachments,is true and correct to the best of
his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may
result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to pr de access a right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
re ncty re fired later in ect' ns.Access and right of entry to this property shall be requested and shall occur only during regular business
ours. /
Signatur J3C r !�� Date: ,,,/!//Q (,
--
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 a ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)
ev n if oic
omplianc it the Jeffers n County development code.The Applicant acknowledges that he,she or it holds individual and non-
rans abnsib'lity r �ng to a complying with the ESA. The Applicant has read this disclaimer and signs an dates it below.
Signatu a - y�i.e-�
Date: f/2/�Q(�
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
• BUILDER STATEMENT •
The signer 9 his state nt does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be ass min?J t responsi lity f th General C p the proposed project._ /
Signature: / �(it �h� a � Date: 1' i / '�Ow
Li
EN�RAL NTyy��CTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
MAILING ADDRESS: 2 Jr LJ .3 /0 �� ��-7 kh EMAIL:
CONTRACTOR'S LICENSE ,/ ^U l WAINS
NUMBER: &u Y RI H V (9(t v" NUMBER 4‘)///AJSQ z co
ARCHITECT/ENGINEER: PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Project
g'Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank Height: ❑ C_ornmunity System
❑ Alteration/Remodel ❑ Concrete Total: Z. W,Individual System
./ /„
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition Cl Other: Bedrooms: Water Supply:
Existing: _ I77 Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: - `a_ EVPublic
Total: _oZ. Name of System: pie 6
ELNCrz'c
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
❑ Underground Tank ❑ Above ground Tank Size of Propane Tank:
❑ Heat Stove 0 Cook Stove 0 Woodstove 0 Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all property lines, buildings and septic system components,
including the reserve area.
ri �' t'.'t *11. 1:. % '{1j r e'T`P y it x
4 i , ` T L-K.. c n;` •' '"4:4 ,.
Square Footage Current Proposed r.cY s Taro ! , k' � ,f �°�' ' k
Main Floor Heated ll , 1 j EH Bld App Review: / G
�o /��a fN,#` (O J .00
2f°Floor Heated �`'
�� �� � �5,� Consistency Review:
:.A ..,e l 53.oO
Other Heated �"° Base fee:
Mezzanine �" F x i
I t I .,qjAdditonal Section: - .• ,
• L.
Heated Basement ��` , Plan Check fee:
AUG cc�� float ,, r 3
Unheated Basementillt" , ir,:4v State Surcharge fee:
s r
$ .? 6
Other Unheated Pot Water Review fee:
Ifi[H l% CUUNT( 5.1: ,.�p-4 ra: t)
Garage/Carport !,, ,� ...if. ,
4.1- SUBTOTAL
z4.§x al7I • bb
Decks w r . f 91 /Rd Approach fee:
3 x 3 /8 r . ' : : ii�P o5-q S3 �/s+ ,el 401
Other i 17.v, TOTAL: $
Li M. COI
D xa2 V gvd 1i „(2,14,4 i Vgo t4.4
r Receipt Number: 485"t
� Cash/Check Number: ��'
• r' . x
ESTIMATED COST(REQUIRED) Date: g II ��
•Fair market value of all labor and materials foundation to finish
Initials:
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
•
• 0
IR EC j I r(4.- ON-cw,
, i JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT 9,- - "(7"
i
\&....... p -.4t,. 4 621 Sheridan Street • Port Townsend • Washington 98368
OA•O 360/379-4450 . 360/379-4451 Fax c (iNn1 C M�ff ,Ij
N http://www.co.jefferson.wa.us/commdevelopment/ � �f E dIV �l1 NJY ��F
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# - 8 PROJECT/APPLICANT NAME: ji/ii-62/j // 1L..
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. Describe he existing vegetation. Indicate native vegetation areas on the site map.
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4. Describ the eexistingpsoils. Indicate soil type on the site map.
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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.
APPROVED
6. Describe any excess levels of noise generated by the proposed use or activity: STORM-WATER PLAN
/ 6
SEP 2 2006
Store w er is \ JEFFER C 'NTy
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stormwater site plan template-rev.10✓1/2003 ` 5
• • 7
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.
g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30
in the Manual) or, if not, what types of stormwater flow control will be utilized for the site or specific threshold discharge areas
within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities.
/1/? /9
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.]
2 0/7
11. Describe the performance goals and standards applicable to the project.
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12. Describe the flow control system. ? t '' . 41 N' E .
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JEFFERSON COUNTY DCD
stormwater site plan template—rev.10/1/2003 6
• .
13. Describe the water quality system. iCw1T''�
‘,.,77/7
14. Describe the conveyance system analysis and design. JEFFERSON-CM UR
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. L.--
--71/7/1,;)
17. Describe the proposed surfacing material.
44,
18. Describe methods for restoration of the site.
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 art required to control flow or treat runoff.] If included,list the Manuals
here. /
(//1
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.
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. C�1�C�t�r
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2. Est lish Couon Access. O r14. szt,_
3. Control Flow Rates.
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4. Ins I Sedi 'e C
ntt ' trots.
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5. Stabilize Soils.
6. Protect Slopes.
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7. Protect Drain Inlets. �
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JEFFERSON COUNTY DCDihRibl 'AMA)
stormwater site plan template—rev.10/1/2003 8
• •
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets. ( if\ rut w
9. Control Pollutants.
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10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
7/7/47
11. Maintain Best Management actices MPs .
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12. Manage the Project. (c,,,ircz,6*c
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
7)//1
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. of RMIT # BED
a. Description of environmentally sensitive areas that are on or adjacent to the sit
/////
A -FESS44„ ATY IICb
stormwater site plan template—rev.10/1/2003 9
• • •
.
b. Description of special requirements for working in or near environmentally sensitive areas.
--?A
4. Erosion Problem Areas. Description of potential erosion problems on sitein the context of the characteristics of the on-site
soils(e.g.,erodibility,settleability, permeability,depth,texture,soil structure).
i- ----7/i/i4 i
5. Construction Phasing.
a. Construction sequence L �,
l� L 7�_.. ,44.'� l 7 {M1;, :n:�LQ ( (.�E/�' Llr%'�C..; z' �/`: 3j�.:� }/G/C4 1 f'Z
.-}jc ^e 4 <_.- 4 L 9 v . 4., !(.%.zi-</C? (.--
b. Construction phasing(if proposed) i`//
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. r Provide a proposed construction schedule.
� 1��i I�(_._ .-4;� fJ. ;..i.r! ,r�>� f t-;Ie 7 2.r g% 'e`1x-C L __ 1e1/.- 7/i-i(._ ,0 6 t"
II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
b. Proposed wet season construction activities for environmentally sensitive areas.
7//mil
7. Financial/Ownership Responsibilities.
a. Identify t - •roperty owner responsible for the initiatii of bonds and/or other financial securities.
N / �y�
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. l 1E(C 1-a IVEi�j
b. Diversions.
c. Waterways. PER I # BED
d. Runoff/Stormwater Detention Calculations < A ems+ i d
) 6 -- 05O7
JEFFERSON t 1t t :l J-ii,l iY (J
stormwater site plan template—rev.10/1/2003 COUNTY U N TY D C D 10
• • .
Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems, treatment facilities,flow control facilities, or structural source control BMPs
(not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as
constructed.
APPLICANT SIGNATURE
By signing the Construction 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 propertj.
'il\ ' -\-------) ” i ),4. // 7
N OR
ER OR AUTHIZE REPRESENTATIVE SIpNATURE).6,404
(DATE)
/-(, ?(_.4:,4,6
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
PERMIT # RLD
06 0507
JEFFERSON COUNTY DCD
V e.. -'-�i .3. ke'1E YJ
12
stormwater site plan template—rev.10/1/2003
•
• •
RETURN ADDRESS
FIRST AMERICAN TITLE COMPANY
2037 EAST SIMS WAY
PORT TOWNSEND, WA 98368
L7 STATE mOF t wfASHINGTON MANUFACTURED HOME AS CH CK ONE
ELIL1l TAT rn
TITLE ELIMINATION
APPLICATION
IICEflSIflG ❑TRANSFER IN LOCATION
Anyone who knowingly makes a false statement of a material fact Is guilty ❑REMOVAL 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)
SDLX-48063 2006 KARSTEN 48 X 28
LAND LEGAL DESCRIPTION ON PAGE
MANUFACTURED HOME WILL BE EN AFFIXED ❑ REMOVED REV6PROPEflF�YrTAx�RAfIC L NUMBER
L0T41 & 42 BLOCK 1L .T&S ale Acre tracts L /Vl1 SECTION/TOWNSHIP/RANGE
GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS
1 1
NAME OF REGISTERED OWNER
JOHNEEN VALERI GUSTAV
NAME OF ADDITIONAL REGISTERED OWNER
ADDRESS CITY STATE ZIP CODE
1074 OAK BAY RD PORT HADLOCK WA 98339
NAME OF LEGAL OWNER
WASHINGTON FEDERAL SAVINGS
NAME OF ADDITIONAL LEGAL OWNER
•
ADDRESS CITY STA I CODE
191 W WASHINGTON ST SEQUIM WA 83L
GRANTEE
NAME
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THA E /ARE THE EGI ERED �� R(S)OF THIS
VEHICLE AND THIS INFORMATION IS ACCURATE:
Signature of Registered Owner and Title,IF APPLICA:LE
Signature of Additional Registered Owner and Title,IF APPLIC•B •
NOTARY S``l cflkk ffrhD//,/4 I NOTARIZATION/C - Fl ATION FOR REGISTERED OWNER(S)SIGNATURE
`• �G :•••••Mc,�•$iate of Washington J E F F ER S 0 N Signed or attested
�'(v�• �1 AR Y •'•� County of __ befor�, on . �i
OBI• /41/<-4.--
Signature; �15,2� I,g=JOHNEEN VALERI GUSTAV
• -RRINT NAME OF REGISTERED OWNER OTA77r R AGE
PL NJ`'• Ug L
•��„yT�•••...••• > PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
C_ OF V,
County/Office No.OR
//�'/////I I I Title AND: Dealer No.OR c +e-6,2a8
DEALERSHIP POSITI /AGENT/NOTARY Notary Expiration Date
al TITLE COMPANY 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
FIRST AMERICAN TITLE COMPANY OF JEFFERSON COUNTY
SIGNATURE/POSITION DATE
lr5/2 'O6°'
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Re esentative signs.
BUILDING PERMITOFFICE CERTIFICATION
I Certify that: "6the manufactured home has been affixed to the real property as described.
a building permit has been Issued for this purpose and the attachment will be inspected upon completion.
NAME(TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONES BLDG PERMIT k
� 1t e DONN\Q_ Juk.drr ('(E70) ay 040- Do5G1
SIGN TU /POSI ION
TD-420-729 M NUF HOME APPL(R/8/98) R Page 1 of 2
• •
•
la SIGNATURE OF LEGAL OWNER
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE/REMOVAL FROM REAL PROPERTY.
Signature of Legal Owner and Title,IF APPLICABLE
Signature of Additional Legal Owner and Title,IF APPLICABLE
NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S)SIGNATURE
State of Washington Signed or attested
County of before me on
by Signature
PRINT NAME OF LEGAL OWNER NOTARY OR AGENT
•
by
PRINT NAME OF LEGAL OWNER PRINTED NAME OF NOTARY
County/Office No.OR
Title AND: Dealer No.OR
DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date
D LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office
0 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(TYPE LyOj�PRINTED) (Z-t
< `4 � WA DEALEaNUMBERDATE OF SALE
�"dVl. I /'(7L v( 12/�z/v(p
PiRCHAS PRICE C0 TAX�SDICTION/TAX(RATE DEALER'S HORIZED SIGNATURE
' 113 O .`I"10
❑ USE TAX EXEMPT Sale to a Certified Tribal member on the reservation(attach notarized statement of delivery).
Q 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 OPERATOi44JUMBER
SIGNATURE
DATE i
10 TITLE FEES
FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX SUBAGENT SEES
TOTAL FEES&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.
11 you need special accommodation,please cal(360)902-3600 or TDD(360)664-8885.
TD•420-729 MANUF HOME APPL(R/B/9B)OR Pape 2 0l 2
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i ON—SITE WASTEWATER PLANS
Y. x TAX PARCEL il 962-700-043 SOILS APPL I CA TION, INC
m .
863 CAR!SRORC ROAD, SUITE A,
SHALLOW PRESSURIZEDSYSTEh1 FOR SEQUIM, WA 98382
W • VALFf7! GUSTAV
PH (.360) 683--6300 FAX (360) 683-5652
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