HomeMy WebLinkAboutBLD2007-00026 •(JILDING PERMIT APPLICA Tifi N MRA0700035 N
Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00026 Received Date: 1/30/2007
SITE ADDRESS: 195 TODD RD
PORT LUDLOW, 98365
OWNER: HAROLD ZASKE PHONE: (360) 437-8224
JERIZASKE
231 COURSEY LN
PORT LUDLOW WA 98365-8708 INGRAM HEIGHTS
SUBDIVISION: Block: Lot: 3
PARCEL NUMBER: 961400003 Section: 8 Township: 28 N Range: 01 E
CONTRACTOR: RIGGS CONSTRUCTION PHONE:
PO BOX 3
PORT GAMBLE WA 98364-0003
Contractor's License RIGGSC*028RW Expires 5/2/2008
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr NEW SFR W/ATTACHED GARAGE
ALSO A/G 250 GAL PROPANE TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 2,797
VALUATION 281,313.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2003 HEAT BASE: HEAT TYPE: PRO
OCCUPANCY: R 3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: 899 SHORELINE:
CONST TYPE: DECK: 400 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: 2WELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 3 Prop: 3
Total: 3 Total: 3
Routing Date:
11A)1011 67)
Type Amount Paid By: Date: Receipt: )pPPd/vtD
Permit $2,012.95 KAS 01/30/07 87255
Plan Check $1,308.42 KAS 01/30/07 87255
State Building Code $4.50 KAS 01/30/07 87255 FEB e} 2007
Potable Water Application $58.00 KAS 01/30/07 87255 Jefferson County Planning
Total: $3,383.87 &Building Department
Jefferson County Building DivSon Permit Numbei.
Applicant: ZASKE
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2003 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks
2/i3/07
Erosion Control p r
' Val 67 "f eV
.Foundation Footing
04
Footing Drains
,/� e4/ D — DRY OUT PRIOR T� ir'or, i2
3//3/6 7 �!
Ioundation Stem Wall 3/747 i
Underground Plumbing
WA
Straps(hold downs)
5Men • gii 0 K
Ext. Shear Wall Nailing
s/9p17 o K
• Rough-in Plumbing
• y Framing 5/9/07 6 K 1
/ FAoL>b 5/'I/o9/1 Cavocrws /pa„es t re,s�ri)
51�� -1 N��> UNPISZt'LeTit FRA MILK.j p K 3/,3/o'7 W GII'
.Blocking _• t�
Airseal 6/G6 I
Insulation:Walls
Insulation: Floors
Insulation:Ceiling
IIif yC,7 ,;,,--
Int. Shear Wall Nailing
5/4/o7 At /A-rELW' O 5.8. SwEAwwc s
Wallboard Nailing
Gas Line: Interior
5/g/o7 o
Gas Line: Exterior
07/57 eje
Propane Tank
7/7/7 o�
Heat/Chimney Clearance
01(1()7 Al CoAss rDEP[ACE e411,1 PIEr OK
Drywell/Alt Drainage
7//7/a7 , 41<
Address Posted
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111 ✓
FINAL INSPECTION /I/t/L' /y
c,r 4 i he.L. I /i '
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDIN BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
5ON cps JEFFERSO�OUNTY • RF1IiJiy7r
`.j DEPARTMENT OF COMMUNITY DEVELOPMENT )
` 621 Sheridan Street • Port Townsend • Washington 98368
4.110), 360/379-4450 • 360/379-4451 Fax a 3 3 ^/
gsN �p www.co.jefferson.wa.us/commdevelopment
f fi: �1,,��
Master Permit Application MLA: �I `U!�- i ',rt
Project Description(include separate sheets as necessary): wry
s i 72 c! C T7 v:a� .0 r� �/nJ Cl L L e� /-f'Yrr i L ra-1 E c1 % /leil ezt`
Tax Parcel Property
Number: 9 I — 4OZJ -a y.3 ,-. Size: C 9 3/ */GCS (acres/square feet)
i tv �� . :sy1-rr» C S + /L-r u ,L c r r,i/c d 4 l•t. .�(..�_ f,
Site Address and/or Directions to Property: / S 3 i) k' i 'r X.64, Gt��+JI kJ 'y 3
Property Owner(s)of Record: 14#97.0- <- JG rT--C i-}-j
Telephone: 3 o -43 7 E?224 Fax:34, e --4 37- e224 email:/ -74 `> e)
Mailing Address: 2-3/ if le 4- y L;c.y x "e= r G c zp(� _..�/ eu 7',613e
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
,uilding i Variance(Minor, Major or Reasonable Economic Use)
I Demolition Permit I Conditional Use[C(a), C(d), or C]**
Single Family t Discretionary"D"or Unnamed Use Classification
71 Garage rAffachett/-Detached t Special Use(Essential Public Facilities)**
Manufactured Home 1 Boundary Line Adjustment
1 Modular i Short Plat**
i Commercial* i Binding Site Plan**
1 Change of Use 1 Long Plat**
1 Address 1 Road Approach 1 Planned Rural Residential Development(PRRD)/Amendments**
/41 Propane t Plat Vacation/Alteration**
1 Allowed"Yes"Use Consistency Analysis Shoreline Master Program Exemption/Permit Revisions**
1 Stormwater Management I Shoreline Management Substantial Development**
1 Site Plan Approval Advance Determination (SPAAD)* 1 Shoreline Management Variance
i Temporary Use i Comprehensive Plan/UDC/Land Use District Map Amendment
Wireless Telecommunication* I Jefferson County Shoreline Master Program Amendment
i Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre-Application Conference **Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applic do that he or she wants Rrior Oise.
Signature: , �� Date: / z1'7
The action or actions Applicant will undertake as kresult 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 disclaim and sins and dates it below.
Signature:;� r'f1 /G Date: ' Wit,/..)-t72j
G:\PertnitCenter\FORMS\DRD FORMS\Master Permit App''ca*+on 07--142006.doc
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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 R MANUFACTURED HOME INSTALLER: PHONE: FAX:
i s n,re, (360) 7/�-3/ / (366 ) 775353�^s3
MAILING AD SS: 7:;;Q , jQzyrc , 6tiviy4,6,, 7g3Py EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: . /G65c E'&)
O 3. NUMBER
ARCHITECT/ENGINEER: 0A,A. Grn.rsi,t i a PHONE (j 6a�y' /_Sto. FAX ( ' 0) Pi_ iS'6,r7
MAILING ADDRESS: 67S c ` '" `4L"'4`/ , fl'c A
lfrdic4e.. AIL C &Lc/C ,, Ct,v4 C�,, 1/0/l,'/Zell,N'p
Project Type: Frame Type: Bathtooms: wig Shoreline: Type of Sewage Disposal:
tiNew Wood Existing: 0 Sewer
Addition 0 Steel Proposed: .2 lz_ Bank 0 Community System
❑ Alteration/Remodel ❑ Concrete Total: 24 z— Hei , t4 A Individual System
❑ Repair El Masonry /iiJJ SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: pp y
Type of Heat: Proposed: 3 Q-- 0 Public e well Two Party
(a t�tR-t C.- Total: 3 /Vr' Name of System:
If this is a Commercial Proiect 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:
[�U erground Tank 1Qbove ground Tank Size of Propane Tank: 2 Z,)
seat Stove ['Cook Stove ❑Woodstove ['Fireplace Insert ❑Hot Water .- Ii Pellet Stove Ij Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated I a 7 -7 _ 1,4151'EH Bld App Review: cc
2nd Floor Heated ) onsistency Review:
Other Heated Base fee: R DI
"A
+ i5
Mezzanine b r Q 1 ' Additional Section: _ _--------------,
Heated Basement Plan Check fee: I Lr
Unheated Basement i .` State Surcharge fee: LI .5b
Other Unheated Pot Water Review fee:
Garage/Carport '1 I .rti.\ q 1co
C`I -
1
1 �1,1�1.`�� SUBTOTAL 3(,01 $rl.
Decks 911/Rd Ap roach fe
Other 1 TOTAL: $
Receipt Number: S '7 K5
Cash/Check Number: •_J�
ESTIMATED COST(REQUIRED) Date: I 1
101
•F4rmarket value of all labor and materials foundatio finish.
- _2- 00�- - ^�1( l;5lnitia )ls l
D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc
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CONDITIONS for Building Permit# :BLD07-00026
1.) NO OCCUPANCY PRIOR TO FINAL OF SEP06-249
2.) PRIOR TO OCCUPANCY MUST SUBMIT RECORDED NOTICE TO TITLE FOR
BEDROOMS.
3.) MUST MAINTAIN MINIMUM OF 5' SETBACK BETWEEN SEPTIC TANK AND BUILDING
FOUNDATION.
4.) 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.
5.) Jefferson County has determined that the use of real property for agriculture and forestry
operations is a high priority and favored use in the county. The county will not consider to
be a nuisance those inconveniences or discomforts arising from such operations, if such
operations are consistent with commonly accepted best management practices in
compliance with local, state, and federal laws. If your real property includes or is within
five hundred (500) feet of real property designated as Rural Residential 1:10 or 1:20,
Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to
inconveniences or discomforts arising from such farming and forestry operations,
including but not limited to noise, tree removal, odors, flies, fumes, dust, smoke, the
operation of farm and forestry machinery during any 24-hour period, the storage and
disposal or manure, and the application of permitted fertilizers and permitted pesticides.
One or more of these inconveniences may occur as a result of agricultural and forestry
operations which are in conformance with existing laws and regulations.
6.) The applicant is proposing to create or add 14,000 square feet of impervious surface and
48,776 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require the
project applicant submit a stormwater plan meeting Minimum Requirements#1 through#5
of the Department of Ecology Stormwater Management Manual for Western Washington.
The stormwater plan shall address measures to control stormwater, erosion and sediment
during construction and shall address permanent measures to stabilize soil exposed
during construction, and in the design and operation of stormwater and drainage control
systems.
7.) 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.
8.) Jefferson County determined that this proposal is categorically exempt from review under
the State Environmental Policy Act(SEPA) pursuant to WAC 197-11-800(1)(b)(i).
9.) The site plan as submitted with the building permit application on January 30, 2007 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 February 16, 2007 shall be
resubmitted for review and approval by Jefferson County Department of Community
Development.
10.) This approval is for a single family residence with attached garage, deck and 250 gallon
above-ground propane tank 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 2 unlicensed vehicleSZ'fiall be stored on any lot unless totally scred
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.
13.) Minimum setback from Todd Road right-of-way shall be 20 feet. Minimum side and rear
yard setbacks shall be 5 feet.
14.) 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.
15.) 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.
16.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
17.) The building height is not to exceed 35 feet.
18.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
19.) A Declaration of Restrictive Covenant has been recorded on February 13, 2007 under
AFN 520389 because the septic system has a limited capacity for 3 bedrooms only.
20.) The parcel has been designated as RR 1:20 under the Jefferson County Comprehensive
Land Use Map effective August 28, 1998.
21.) The lot was created through the Ingram Heights Long Plat on September 22, 2005 under
AFN 503348.
22.) An address of 195 Todd Road, Port Ludlow has been assigned to the parcel. Todd Road
is private (P616).
23.) A road maintenance agreement was recorded under AFN 503346 at time of subdivision
approval.
24.) The lot is served by a two-party well that has a recorded well agreement under AFN
503351.
25.) A septic permit(SEP06-0249)was approved on October 2, 2006. An address
(RAP06-0238) of 195 Todd Road has been assigned to the parcel.
• •
JRECEWT1i)
rii,
q, JEFFERSON COUNTY4.4, . ` U
DEPARTMENT OF COMMUNITY( DEVELOPMENT
621 Sheridan Street • Port Townsend .DINE
Washington 98368 �(j i { ft�f! 1
360/379-4450 • 360/379-4451 Fax JEffrl!p�� "I 1 1 1 IIJ I 'J CD
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http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# PROJECT/APPLICANT NAME:/447001_,6/je?_/ f4s/eic
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 the existing veeaetation. Indicate native vegetation areas on the site map. a
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4. Describe the existing soils. 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.
Ah lye_ • 6726 , /4'0 .6 S 4v4-7 -72_
APPROVED
STORMWATER PLAN
6. Describe any excess levels of noise generated by the proposed use or activity:
K/ONL•—
FEB 10 2007
StormWa
Require !f\si JEF s ,
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stormwater site plan template—rev.10/1/2003 Illr ` 5
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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.
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
withi the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities.
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10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed
for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is
normally for large"projects or projects that involve the potential for dispersion of contaminants.]
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11. Describe the performance goals and standards applicable to the project.
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12. Dcie th�4 floyv controlyttem. IR Ec MIFF)
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13. Describe the water quality system.
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14. Describe the conveyance system analysis and design. r
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15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
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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
here.
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
Ai 4
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.
storrnwater site plan template—rev.10/1/2003 7
• S
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.
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4. Install Sediment Controls.
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5. Stabilize Soils.
6. Protect Slopes.
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7. Protect Drain Inlets.
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stormwater site plan template—rev.10/1/2003 8
• •
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
9. Control Pollutants.
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 P oject. /�
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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).
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
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3. Environmentally Sensitive Areas. 1R1a(( ITYPT)
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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stormwater site plan template—rev.10/1/2003 9
• !
b. De cription 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).
5. Construction Phasing.
a. Construction sequence
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b. Construction phasing(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 season construction activities for environmentally sensitive areas.
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7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
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b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
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8. Engineering Calculations. Provide Deign Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps. 46,7_�L RECEIVEDb. Diversions. /t./ A/ -es._
c. Waterways. /va/'1_.
d. Runoff/Stormwater Detention Calculations AlZ�o' ) `;
tif,a 3 i
JERHSOI\ 11111NIk 11C1l
stormwater site plan template—rev.10/1/2003 10
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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.
,/ 41"/./
04/17
(LANDOWNER OR AUTHORIZED REP SENTATIVE SIGNATURE) ( TE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
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