HomeMy WebLinkAboutBLD2009-00156 3UILDING PERMIT APPLICA DN MRAOwTOp7I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00156 Received Date: 5/27/2009
SITE ADDRESS: 287 ADELMA BEACH RD
PORT TOWNSEND, 98368
OWNER: MATTHEW S HENERY PHONE: 360-379-1318
TARA L HENERY
287 ADELMA BEACH RD
PORT TOWNSEND WA 98368-9605 TAX G29
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001324079 Section: 32 Township: 30 N Range: 01 W
CONTRACTOR: SHOLD EXCAVATING PHONE: (36)385-0480
PO BOX 179
PORT HADLOCK WA 98339
Contractor's License SHOLDI*224LT Expires 7/9/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI ROCK RETAINING WALL
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 10,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0
Total: 0 ----Total: 0
Routing Date: —�
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $181.25 LYK 05/27/09 108514 APPROVED
Plan Check $117.81 LYK 05/27/09 108514
State Building Code $4.50 LYK 05/27/09 108514 JULa( 2009
Total: $303.56
Jefferson County Planning
& Building Department
Jefferson County Building Stion Permit Number: BLD09-00156
Applicant: HENERY
BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 2006 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
Foundation Footing Base Course
Footing Drains q--n ,� ,. Per Plan j iJ._</.. .. _Gy
fi �C.>�I `C'V
FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD09-00156
1.) PROVIDE ENGINEERING OVERSITE: The Engineer of Record shall provide project
oversight and provide an over-signed letter accepting the retaining wall as built to the
approved engineering standards for rock retaining walls and the approved construction
plans prior to Final Approval by Jefferson County DCD.
2.) A SILT FENCE SHALL BE INSTALLED LANDWARD OF THE LANDSLIDE HAZARD
AREA BUFFER PRIOR TO ANY LAND DISTURBING ACTIVITY.
APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO MAKE SURE THAT SILT
DOES NOT ENTER THE STREAM. IF NECESSARY A SILT FENCE SHALL ALSO BE
INSTALLED SOUTH OF THE 55 FOOT STREAM BUFFER.
THE MINIMUM HEIGHT OF THE TOP OF SILT FENCE SHALL BE 2 FEET AND THE
MAXIMUM HEIGHT SHALL BE 2 1/2 FEET ABOVE THE ORIGINAL GROUND
SURFACE.
THE SILT FENCE SHALL BE BURIED IN A TRENCH TO A MINIMUM DEPTH OF 5
INCHES BELOW THE GROUND SURFACE. THE TRENCH SHALL BE BACKFILLED
AND THE SOIL TAMPED IN PLACE OVER THE BURIED PORTION OF THE SILT
FENCE, SUCH THAT NO FLOW CAN PASS BENEATH THE FENCE AND SCOURING
CAN NOT OCCUR.
ANY DAMAGE TO THE SILT FENCE SHALL BE REPAIRED IMMEDIATELY.
SEDIMENT DEPOSITS SHALL EITHER BE REMOVED WHEN THE DEPOSIT
REACHES APPROXIMATELY ONE-THIRD THE HEIGHT OF THE SILT FENCE, OR A
SECOND SILT FENCE SHALL BE INSTALLED.
3.) Mulch material may also be utilized as an immediate temporary cover protection measure
from erosion. Mulch also enhances plant establishment by conserving moisture, holding
fertilizer, seed, and topsoil in place, and moderating soil temperatiures.
Mulch should only be used:
(a) on disturbed areas for less than 30 days;
(b) as a cover for seed during the wet season and during the hot summer months;
(c) during the wet season on slopes steeper than 3H:1V with more than 10 feet of vertical
relief; and
(d) mulch may be applied at any time of the year and must be refreshed periodically.
The thickness of the mulch cover must be maintained. Any areas that experience erosion
shall be remulched and/or protected with a net or blanket. If the erosion problem is
drainage related, then the problem shall be fixed and the eroded area remulched.
4.) CONSTRUCTION ENTRANCE.IALL BE STABILIZED WHEREVER TRAFF WILL
BE LEAVING A CONSTRUCTION SITE AND TRAVELING ON PAVED ROADS OR
OTHER PAVED AREAS WITHIN 1,000 FEET OF THE SITE.
THE ENTRANCE SHALL BE CONSTRUCTED ON A FIRM COMPACTED SUBGRADE.
QUARRY SPALLS (OR HOG FUEL) SHALL BE ADDED IF THE PAD IS NO LONGER IN
ACCORDANCE WITH THE SPECIFICATIONS. (BMP C105, 2005 DOE STORMWATER
MANUAL).
ANY SEDIMENT THAT IS TRACKED ONTO PAVEMENT SHALL BE REMOVED BY
SHOVELING OR STREET SWEEPING. THE SEDIMENT COLLECTED BY SWEEPING
SHALL BE REMOVED OR STABILIZED ON STIE.
ANY QUARRY SPALLS THAT ARE LOOSENED FROM THE PAD, WHICH END UP ON
THE ROADWAY SHALL BE REMOVED IMMEDIATELY.
UPON PROJECT COMPLETION AND SITE STABILIZATION, ALL CONSTRUCTION
ACCESSES INTENDED AS PERMANENT ACCESS FOR MAINTENANCE SHALL BE
PERMANENTLY STABILIZED.
5.) 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.
6.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
7.) 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.
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 automobile 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 requirements 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.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
11.) The building height is not to exceed 35 feet.
12.) Minimum building setbacks from Adelma Beach Road right-of-way shall be 20 feet.
Minimum side and rear yard setbacks shall be 5 feet. Retaining walls are exempt from
setbacks and may be placed on the property line per Jefferson County Code (JCC)
18.30.050 Table 6-1, Note 6.
13.) 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.
•
14.) 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.
• •
7.--.40N` li �6 JEFFERSON COUNTY
h ' DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
qs ov www.co.jefferson.wa.us/commdevelopment
BINS
Master Permit Application MLA: GCI -- ( -1 1
Project Description(include separate sheets as necessary):
N t VAr (-.i!1"4-(_
Tax Parcel Number: 00 k 3 L Li 0-1 9 Property Size: j Y
rh Q,(.- f.'S (acres/square feet)
Site Address and/or Directions to Property: c7, 7 Ade/ma_8e4 /?''. Po,-/- 7i-4ense,-,q!
Property Owner(s)of Record: /flt27 jet f 7teener
Telephone: 3(oO-37 q /3l8 Fax: ¢ 3-e5" 51O O
email: mi-heti e_r e � �4 caw.
Mailing Address:�$7 Ctdeinzi beach 2p(. Art7f fen, WA ,786626
c� cJg
Applicant/Agent(if different from owner):
Telephone: Fax:
email:
Mailing Address:
W-hat ind of P it?(Check each box that applies ❑ Lot or Road Segregation
--uilding crIm:`h` Q-.\ 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home 0 Modular - 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use ❑ Boundary Line Adjustment
❑ Address 0 Road Approach ❑Short Plat**
❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan**
❑ Propane 0 Long Plat**
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference ❑Tree Vegetation Request
**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:
Ey 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 its 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 application that he or a wants prior notice.
Signature: cj/2Lg. MAY 2 / 2OOjate: 5/610 9
The action or actions Applicant will undert a 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".Qr"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issue 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 re'n compliance with the Jefferson County development code.The Applicant acknowledges that he;she or it holds individual
and non-transfera ponsibility for adhering to and complying with the ESA. The Applicant has read this disclai er an signs and dates it below.
Sign e:
Date: S(27 c)}
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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.
1ttl i Date: 5 -�? r✓ 1
signature:z� I
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER:
PHONE: FAX:
Sit r,4-1 1-7CC a v c7,.. ,�,D (30) 38 `-0480 (360)-33.c( '6 Z
-f, .c
MAILING ADDRESS: C" - U . Fj c:)4-- s,Ci r c .-}-Kr k C"C� EMAIL: (UJ�U� 5 D C.a, c y 0.,NUc .a,
CONTRACTORS LICENSE I V 1 OD�r )1 "— c�wc Rg"SV-1 WAINS
NUMBER: (, - 3 NUMBER S L A. Da`( L 1
n
ARCHITECT/ENGINEER: l�1����� �10C
i�{ /GL. F.F'So r"‘ PHONE (3CO)S31—iQi l FAX:( )
MAILING ADDRESS: 3 f�.v 30 C d /c+ C,(,., 5-4_ PT• 78368 EMAIL ,:i e,n.1 r��e 2 0 c,-b le,$'� r rc.� . co-'
ject Type:
rFrame Type: Bathrooms: Shoreline. Type of Sewage Disposal:
New [1 Wood Existing: ❑ Sewer
❑ Steel Proposed: Bank ❑ Community System
❑ ddition Total: Height: ❑ Individual System
❑ Alteration/Remodel ❑ ConcreteSEP Permit#
O Repair ❑ Masonry
Other: •� Bedrooms: Water Supply:
O Demolition Skz�h�.5 Existing: Setback: ❑ Private well ❑ Two Party
Proposed: ❑ Public
Type of Heat: Total: Name of System:
If this is a Commercial Project you must answer the following: ADA Parking Spaces:
Number of Parking Spaces: Current: Proposed: Number of Proposed
Number of occupants(includes owners,tenants,employees,etc) Current p
Type Occupancy:
IBC T e 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:
i Underground Tank i Above ground Tank Size of Propane Tank:
1 Heat Stove i Cook Stove I Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove I 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 FootageoUnt . 139Asion
Current Proposed For Office Use Ginty. , '- f
Main Floor Heated EH Bid App Review: y3 O4
tJ-
Floor Heated Consistency Review: 2 L 3`0 6
Other Heated Base fee: / G/. 2 S
Mezzanine Additional Section: o (.-------
Heated Basement Plan Check fee: [/ -7,/ ��
Unheated Basement State Surcharge fee: ![, J
' Other Unheated
Pot Water Review fee:
Garage/Carport SUBTOTAL b
c ?
Decks 911/Rd Approach fee:
Other TOTAL: $ S g' /_5-
Receipt Number: ( /�VVS J- 4
Cash/Check Number: . (,9
ESTIM• ED COST(REQUIRED) Date: �� �
•Fair m.' et value of all labor and materials fo ndation to finish Initials:
10 #300
G;\PexmitCenter\# DRD ORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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Stormwate B - APPROVED
Require �r1& ,.I .►.
• STORMWATER PLAN
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w JEFFERSON COUNTY JUL 2 0 2009
r-3 ,q DEPARTMENT OF COMMUNITY DEVELOPMENT
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621 Sheridan Street • Port Townsend • Washington 98368 1EFFERSO �U
O 360/379 4450 • 360/379 4451 Fax DEPT.DE C'.N ` J r ,.E T
SIG'vATUR
�...... http://www.co.Jefferson.wa.us/commdeveloprneni/ ��j �It lb
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STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# 09k— `—TPROJECT/APPLICANT NAME', fold i W.) f 1 WI
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 vegetation. Indicate native vegetation areas on the site map.
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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.
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MAY 2 / 2009
6. Describe any excess levels of noise generated by the proposed use or activity:
6�. del woes c p(uri.n1 nrnrna� basin ess halu�S
stormwater site plan template—rev.10/21/2008 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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attjai erd it) -two ofhev a d_ A a pevties.
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 T5.3O
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.
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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.
SEA 111
12. Describe the flow control system.
stormwater site plan template—rev.10/21/2008 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 characteristifs 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.
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 re fired for
"large"projects only and only those for which facilities are required to control flow or treat runoff.] If included, list the Manuals
here.
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20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
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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.
MAY 2 1 2009
stormwater site plan template—rev.10/21/2008
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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 Volume II Section 3.2.3 of the Manual (beginning
on page 3-7).
12 Required Elements—Construction SWPPP
1. Mark Clearing Limits.
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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.
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6. Protect Slopes.
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7. Protect Drain Inlets.
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stormwater site plan template—rev.10/21/2008
8
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12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
T -P-(PA Le-
9. Control Pollutants.
Pollutants.
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10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
11. Maintain Best Management Practices(BMPs).
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12. Manage the Project.
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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).
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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.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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MAY 2 2009
4
storrnwater site p!sn temp!ate—rev.10/21/2008
•
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).
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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).
Provide a proposed construction schedule. �
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II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
b. Proposed wet season construction activities for environmentally sensitive areas.
1 &
7. Financial/Ownership Responsibilities.
a. Identify the property owner respPoQnsible 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. /4-
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable.
a. Sediment Ponds/Traps. Aj. 4
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
stormwater site plan template—rev.10/21/2008 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 property.
01. !den
(LANDOWNER OR AUD REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
stormwater site plan template—rev.10/21/2008 12
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