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HomeMy WebLinkAboutBLD2006-00163 • CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 Al Scalf, Building Official PERMIT #: BLD09-00163 SITE ADDRESS: 94 PUGET LOOP Issue Date: 08/5/2009 PORT LUDLOW, 98365 Final Date: 4/7/2010 APPLICANT: CARY CASAL PHONE: 360-301-1778 PO BOX 94 PORT HADLOCK WA 98339-0094 SUBDIVISION: PORT LUDLOW NO 1 Block: Lot: 53 PARCEL NUMBER: 990400153 Section: 9 Township: 28 N Range: 01 E PROJECT DESCRIPTION: NSFR W/ ATT GARAGE & A/G 120 GAL PROP TANK THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006 EDITION. OCCUPANCY GROUP: R-3 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 4/7/2010 • I:\F_BLD_Occupancy.rpt 10/29/19 Jefferson County Building D�sion Permit Nu•: BLD09-00163 Applicant: CASAL BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 2006 International Building Codes To schedule inspections, call (360)379-4455 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 Minimum setback from Puget Loop Road right-of-way shall be 20 feet. L (� Minimum side and rear yard setbacks shall be 5 feet. Erosion Control Foundation Footing Footing Drains Foundation Stem Wall " Underground Plumbing Under Floor Framing b_1'3„D pm, Straps(hold downs) Ext. Shear Wall Nailing Rough-in Plumbing 1D?Sr -09 Framing I0-2A -0x1 Blocking Airseal Insulation: Walls l0-2f'1--a( e Insulation: Floors ; tZ Insulation: Ceiling (mil t e) Int. Shear Wall Nailing Wallboard Nailing 1 1/ 4©q Gas Line: Interior 1 t` ,7' Gas Line: Exterior Propane Tank Heat/Chimney Clearance Drywell/Alt Drainage Address Posted ; 1 b' (0 FINAL INSPECTION � 0 I? FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR MLA09-00183 UILDING PERMIT APPLICON Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00163 Received Date: 6/3/2009 SITE ADDRESS: ct,k PUGET LOOP PORT LUDLOW, 98365 OWNER: CARY CASAL PHONE: 360-301-1778 PO BOX 94 PORT HADLOCK WA 98339-0094 PORT LUDLOW NO 1 SUBDIVISION: Block: Lot: 53 PARCEL NUMBER: 990400153 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI NSFR W/ATT GARAGE & A/G 120 GAL PROP TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,800 VALUATION 198,642.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2006 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: 504 SHORELINE: CONST TYPE: DECK: 60 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: SEW WATER SYSTEM: LUDLOW BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Total: 3 L Total: 2 Routing Date: Type A Date: Receipt: Approved/Date Permit $1,548.15 LYK 06/03/09 108535 APPROVED Plan Check $1,006.30 LYK 06/03/09 108535 State Building Code $4.50 LYK 06/03/09 108535 AUG 5 2009 Potable Water Application $62.00 LYK 06/03/09 108535 Total: $2,620.95 Jefferson County Planning &Building Department 4110 • CONDITIONS for Building Permit# :BLD09-00163 1.) Water line and sewer line must have a 10' minimum separation. 2.) 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. 3.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 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.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 6.) 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. 7.) This parcel is within the Port Ludlow no shooting area per JCC 8.50. 8.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 9.) Per MPR Code Section 3.17, accessory dwelling units (ADUs) shall not be allowed in the MPR-SF zone. 10.) Maximum lot coverage is not to exceed 45%. 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 setback from Puget Loop Road right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 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. 15.) The road approach permit(RAP 0039) must be inspected and finaled by tl 3fferson County Department of Public Wor s prior to the final inspection/certificate of occupancy of this residence. Contact Terry Duff, Department of Public Works at 360-385-9159 for the final road approach inspection. • 411 SON cO JEFFERSON COUNTY e• ' DEPARTMENT OF COMMUNITY DEVELOPMENT mik ` ''4 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 11I p� www.co.jefferson.wa.us/commdevelopment N / Master Permit Application MLA: oq- 1 O3 Project Descri_p tion(include separate sheets as necessary): Tax Parcel Number: q9 b -9 t9c, 1 5 5 Property Size: (r_ ''�., .!- �'f- (acres/square feet) Site Address and/or Directions to Property: 1._ 1 6 Y Po 6 E.7 L.op ?' Po K1 L_u D cot.," Property Owner(s)of Record: CAR.\/ CASAL-- Telephone: 3 60-SON -1-1 S Fax: Ismail: Mailing Address: Vo `3 0 x q y i7o,r-r-Vc,c3..`,oc tc.,(-Jet R g 3 3 9 ;_ Applicant/Agent(if different from owner): Telephone: Fax: email: JUN - 3 2009 Mailing Address: What kind of Permit?(Check each box that applies 0 Lot or Road Segregation XBuilding 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) IN Single Family It Garage Attache Detached ❑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 0 Boundary Line Adjustment ff.Address lil Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** III 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 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 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 -6 Date: C=,f ( 1 4 1 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 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 applicati that or sheyants prior notice. Signature: Date: Ce t i t O 1 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 ibility p for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: le 1 I 0 9 411 • / : -c,--. 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 as Ing th jss onsibility of the General Contractor for the proposed project. —Signature:' �- Date: (' M ) V GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: X. New . Wood Existing: XSewer ❑ Addition ❑ Steel Proposed: 2 Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Z.- _ Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other. Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 3 )4,Public ice`t i%(- Total: - P Name of System: 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: 1 Underground Tank Above ground Tank Size of Propane Tank: 1 Heat Stove X.Cook Stove 1 WoodstoveFireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other Is this appliance being installed in a Man actured/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 at/property lines,buildings and septic system coin one is including the reserve area. ye ;.i ,4,0*-'-'•' ••,':i'::.-.';''',;•..nA ',',1' '4.N1-.YVAill FrP-7:•::".%/, 4:14P,., .','-;:' Square Footage Current Proposed ce-li 4116 ,f,r >_ . '-.,= Main Floor Heated to`1 ),. p - '' EH Bld App Review: i3ya�co,3� iU �. 1 -: D Sty 2nd Floor Heated ,its Consistency Review: a 13. Cc) Other Heated '' ' 'V r Base fee: 5�� 1 lal1, /5 f Mezzanine Additional Section: Heated Basement • Plan Check egg:l 34 ' 00� C) hl Unheated Basement ?, !' State Surcharge fee: Other Unheated. ., Pot Water Review fee: 4.D�( SUBTOTAL Garage/Carport 5 ' - - a._ a ci a)t '29 a87 1 °qs Decks / !^-� 911/Rd Approach fee: r�15 DO bV cif Other . r CT a 1D I atICtOTAL: $ r ° Receipt Number: I o9S j raH__ S:ut�r d. n r , 4,,,,, , ash/Check Number: q^ , COST- (REQUIRED) . te: _a ESTIMATED (� (p�a,('� t 1 •Fair market value of all labor and materials foundat to fini�h - , ~.�---- 'Initials: 2010� c� 13q,3�- �' r•\Permit(:enter\###FORMS###\DRD FORMS\Current DRD Fnrms\Master Permit Annliratinn 5-29-fIR.rine r • APPROVED STORMWATER PLAN "6-4 , gN CJEFFERSON COUNTY AUG - 5 2009 tiDEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 !EPEES N ceNTY • O� 360/379-4450 • 360/379-4451 Fax DEPT.OF C t Y�-bb V OPMEIYT �`S`$INGZ http://www.co.jefferson.wa.us/commdevelopment/ SIGNATURE: STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# DDI I g 3 PROJECT/APPLICANT NAME: ' l R I t-( `5 AL 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. CLEARED. `j OMB 5I44tLL ALpi- gS A FEtM cL DAR'S Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. SLnF'S F O A-. ROA T o TSALk< O t- LOT 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. �`,� J UN - 3 2009 4. Describe the existing soils. Indicate soil type on the site map. - , ()Nr. ,�,nt. 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. VO STAkID10)<� t.,tIATF R. L__of SLoPS 'GEAJT '/ To DITCH AT RcA 6. Describe any excess levels of noise generated by the proposed use or activity: /iO XGI;SS . !' C.LE.Ai ANkD FK : i `G stormwater site plan template—rev.10/21/2008 5 • • . I t 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,et . on the site. Indicate location on the site map. 1. /V/A 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.). /V/(A 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. pOR T LupLow MAINTr..PAly'.F. GOMMISSlov. wfty l D9,A‘ 1,,/A( LUA%ER To D IScNARGF . ,4 ROAD SIDE. D►T-c t-t, 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 9r projects that involve the potential for dispersion of contaminants.] lV, 11. Describe the performance goals and standards applicable to the project. . i^,,/ O/ - % - :. - '.R`/ ONE I,A P t 12. Describe the flow control system. NATIVE \J GT1 AXlo t • stormwater site plan template—rev.10/21/2008 6 • • 13. Describe the water quality system. NSTRVT1ot`t ARID PI,AN 1EFORS LOMMEgS Dvc� 14. Describe the conveyance system analysis and design. P/A 15. Describe the source of fill material, physical characteristics of fill material, and deposition of excess material. AtV it rI 5 7-0 BE- LvM.PAc_i C_D LovER!✓:.D w/5T A1, Vk(,ETATloN Fk T t= i) 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. A?FRoVED METr1ODS r•©Ut\)D ► t\t ( kAPTelR 3 17. Describe the proposed surfacing material. 18. Describe methods for restoration of the site. p � 1 A.�, ;oor1 l QSA,n1_,E 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. 1_I 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. 1—0 Lot-,.) rvt'`. fPA. C, C stormwater site plan template—rev.10/21/2008 • • • 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. LoY iS N D5 i Ltl( Cl CARED 2. Establish Construction Access. (`J `' D R v vAJ A y 1 L,L ( r 0 5 I- 3. Control Flow Rates. 4. Install Sediment Controls. ASS /�,f,,`; \l (� ► t t nv\- t„�1 r C_ L E. F i c-0 .."Nn oL 5. Stabilize Soils. - - , • r� z 11 6. Protect Slopes. • 7. Protect Drain Inlets. 14LGf5 ,4,t2,[— stormwater site plan template—rev.10/21/2008 8 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. No <-NANNEts 0N( Ov` 1_ S ► N AR 9. Control Pollutants. A,1\I `( Poqu7--- 1\1TS w ALL E c ( - .J UP AT ONCE 10. Control De-Watering (the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Management Practices(BMPs). gr'‘.P t4 1vt'J3E ,' O4a FtzooR cry 12. Manage the Project. / Co N T??'\ C) ,_,),LA_ I i ©t) 5�i t�: L. ",. � I t40 �a 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). L_oT iv i-u P K; \` N1,1A . vi 1 (-) � _ �� � C�t -, E 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. stermwater site plan template—rev 10/21/2008 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. NO S N1�. VLF' �t,;.; 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 �C l +oJ 1 / ..ovMbAT10PJ, rRAt Roof 5 1-4.4D12kA1,1 YAKP seFoR Su►A/\✓iN a 1Z S ovER b. Construction phasing(if proposed) �NSI•DF woRK NEXT v\l ( I 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction schedule. START July 1 . ()Li ' io Rk C.o YAP IS A L. II. Wet Season Construction Activities. a. Proposed wet season construction activities. �\-`S k p woRK Lo►kpL t ED ,./ 5Ct45o b. Proposed wet season construction activities for environmentally sensitive areas. Olt\ No 56- tJ5I it 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. 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. • (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormwater site plan template—rev.10/21/2008 12 \ 5 6 1 I / 30 _` 21 / . / r2 4 4 y /� / BP dP I yy' I a / / _c 9r _ C D ' .-> I L 0 0 _ -{ I = m s x o 0 �.o � 1 4-_,' V. N 3 ND r u N (6-- ® ego i x _ n6-,T .. l._—_ _ y / o T ^ /\\ e _ _ c 0 N J 7�!` I L 4 - — u xOOC xo< n37 • °3 o w S '-- I - fi rvJUMO[lofl / al.() c i — / j 6P �89 \ / V o ' Z o • b 0 -{ O N oyes 0_ C'D CP) m r .0'P r;,''. 3 N',F,3 to I z � m t z f 0 p Z D ' I n pZ o O- 32 Z r I -E.__I- 0.3G ,P rsm m _ / x� rn r- N = CC r I N. ?t 2.i C m • r, m m O A_. 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