HomeMy WebLinkAboutBLD2012-00046 A .- -
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� co . JEFFERSOI RUNTY •
DEPARTMENT OF COMMUNITY DEVELOPMENT
1, - ` '.4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451
�qp'� www.co.jefferson.wa.us/commdevFaxelopment
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Master Permit Application MLA: t)- 5
Project Description (include separate sheets as necessary):
A be it hi nl G LE FAi'1 1 L'/ 5 i1 E nl c e Fc.74 Al/c -4 c`_L ..5,,v c'p b'.>of
Tax Parcel Number: -# .96,(5Unt-,76 t 9e.,660rx)7-7 Property Size: .1652./ ,y �,9J (acres/square feet)
Site Address and/or Directions to Property:
boo V,nlTc) totJ6 /N /—.4zY L Di I/. i
Property Owner(s)of Record: 11/1/C-NA-8-z- ' ic./E bbc.,A/
Telephone:(.. &1 19 iv_.�{-St-.o Fax: email: rel"r,,y rn t, k c y 61100- c o41
Mailing Address: /
Applicant/Agent(if different from owner): i dC 1i'E..s,E,,,I/i,.*,.0 - 7744 `�.4c.-1.3& -r-r-
Telephone:(429 g/$ - !S 4 Fax: email:-f/c.cles E ') 1(4 , /c1 e 9irra•1.
Mailing Address: . Pvt.A-c_ar Po,,./-r 101) i &a,A/Abut./ i/1/A 9 '832 v tv
Wh kind of Permit?(Check each box that applies 0 Lot or Road Segregation
146uilding 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
[W"Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C)**
❑ Manufactured Home .0 Modular - ❑ Discretionary"D"or Unnamed Use Classification
❑ * 0 Road Approach ❑Short Plat**
Commercial ❑Special Use(Es gilt Kist
u i
� _.._.--
❑ Change of Use 0 Boundary Line ist►
❑ Addresspp
❑ Home Business 0 Cottage Industry ❑Binding Site Pla **
❑ Propane 0 Long Plat** 1 P, t ,
❑ Sign 0 Planned Rural esidential�eV lo�ment-( ..RD)/• - ments**
❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/AI eratifln**
❑ Stormwater Management ❑Shoreline Mast r Pro• . _ --•: • -- :. •n **
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Man gement,Syr• /a 4 i'Uefalpment**
❑Temporary Use ❑Shoreline Man gement-V is ' "MY DEVELOPMENT
❑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 ally otherlocal,state-orfederal-petirtit6 ruquired-for-this ptupusat;if-knowti.
DESIGNATION OF AGENT
I hereby designate rrk T7ES,44,4 ( teult..D to act as my agent in matters relating gttto this application for permit(s).
/ OWNER SIGNATURE . Date: " 7,'4h 1 Z
/
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 application that he or e wants • ': notice.
Signature: - ! 't//om"- Date:
/The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable responsibility for adhering to etcomping with he ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: //_- ---� �'. _ Date: 9 7/13/2-
/
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.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 OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
7-k OG—si C:nl i e-D 425 fl/•- o '-t, ( / )
MAILING ADDRESS: 3 RI c%�t I 'PO/N r ,B 140ft EMAIL:--r�cie5 n LLt.(i KZ'�` ?frt2{// COp1/
CONTRACTORS LICENSE WAINS /
NUMBER: NUMBER
ARCHITECT/ENGINEER: i_io u., el46.i Aj e e_!-I �6 PHONE ( ) FAX:( )
MAILING ADDRESS: /4— WA P.4r,, illy /L1A-N5o1'I UJ,4 3lEMAIL h0tvz�c, yjwi , n�
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
VNew VWood Existing: l") ❑ Sewer
❑ Addition ❑ Steel Proposed: •Z Bank ❑ C�pmmunity System
❑ Alteration/Remodel ❑ Concrete Total: 2- Height: Vindividual Syste f
❑ Repair 0 Masonry SEP Permit# OK (
- I t
E Demolition ❑ Other: Bedrooms: Water Supply:
Existing: 0 Setback: ❑ Private well 0 Two Party
Type of Heat: Proposed: ?-- VPublic
Total:
E'le-e- Name of System:
44 a G- t,tJ, f<r SLy 5 A-..,
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:
I Underground Tank i Above ground Tank Size of Propane Tank:
I 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 Footage Current Proposed For Office Use Only Amount .-Revision -
•
Main Floor Heated EH Bld App Review:
pn(P 237
o��irh4o
2nd Floor Heated _ Consistency Review: Z 2
— Other Heated. . Base tee: '� 7-7c3
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
l OO
Garage/Carport SUBTOTAL ��
3ioi1 ,
(Decks) 911/Rd Approach fee:
31 Z zo e-kI Sri
Other TOTAL: $
Receipt Number: 13\ ` t4 I
2t,$g2,A0 Cash/Check Number:
(95 L
ESTIMATED COST(REQUIRED) Date:
• arr_m f-e#-labnr anti matedalifoundation to finish I
" !2 OV 0', ro 0 Initials: ` ___-
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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0�� JEFFERSON COUNTY
w �` DEVELOPMENT
� r`.r7 � DEPARTMENT OF COMMUNITY DEVELO ; `\' I� CI ,
0 V r(_,
�-`y ',, 621 Sheridan Street • Port Townsend • Washington'983368 L
lc, �O 360/379-4450 • 360/379-4451 Fax !.r-o ' n
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JEFFERSON COUNTY
Stormwater Calculation Worksheet fFPT OF COMMUNITY DFVFIOPMEN
MLA# -31 PROJECT/APPLICANT NAME: 5 nlCD boA) 'E./L)En.JGf
DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first
to classify the proposal as "small,""medium,"or"large." The size determines whether a Stormwater Site Plan is required in conjunction
with a stand-alone stormwater management permit application, building permit application, or other land use approval application that
involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan, if required.
PARCEL SIZE(I.E., SITE)
Size of parcel .¢SZ acres An acre contains 43,560 square feet. Multiply the acreage by this figure.
Size of parcel in square feet (1 t L{7 sq/ft
Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and
non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling,
excavation,and compaction associated with stabilization of structures and road construction.
Native vegetation is vegetation comprised on plant species, other than noxious weeds, that are indigenous to the coastal region of the
Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as
Douglas fir,western hemlock,western red cedar, alder, big-leaf maple, and vine maple; shrubs such as willow, elderberry, salmonberry,
and salal; herbaceous plants such as sword fern,foam flower, and fireweed.
LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL
Calculate the total area to be cleared, graded,filled, Answer the following two questions related to
excavated, and/or compacted for proposed development conversion of native vegetation:
project. Include in this calculation the area to be cleared for:
Does the project convert' acres or more of
Construction site for structures 2,ooco sq/ft native vegetation to lawn or landscaped areas?
Drainfield, septic tank, etc. /f/A sq/ft Circle: Yes %No
Well, utilities, etc. /v sq/ft Does the project convert 2 1/2 acres or more of
/ native vegetation to pasture?
/
Driveway, parking,roads, etc. /t//4 sq/ft —)
Circle: Yes / No
Lawn, landscaping, etc. /A` sq/ft
•
Other compacted surface, etc. N/A,- sq/ft Indicate Total Volumes of Proposed:
Total Land Disturbance Z t a o(_., sq/ft Cut O Fill 0 (cu/yd)
[over]
stormwater calc worksheet Rev 9-9-2010—REV 9/9/2010 1
Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions
prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow
from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof
tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials,
and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater.
STORMWATER CALULATIONS—IMPERVIOUS SURFACE
NEW EXISTING
Structures (all roof area) 2-, 3z sq/ft Structures (all roof area) I ,zL7J sq/ft
Sidewalks 71-0 sq/ft Sidewalks sq/ft
Patios sq/ft Patios sq/ft
Solid Decks sq/ft Solid Decks sq/ft
(without infiltration below) (without infiltration below)
Driveway, parking, roads, etc (200 sq/ft Driveway, parking, roads, etc sq/ft
Other sq/ft Other sq/ft
Total New 3 al z sq/ft Total Existing I , Zo v sq/ft
TOTAL NEW+TOTAL EXISTING* 4)24 z sq/ft
*This amount will be used BY STAFF to check total lot coverage.
The following questions will help determine whether the proposed project is considered development or redevelopment.
DEVELOPMENT v. REDEVELOPMENT
Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: L' 7 to
Does the site have 35%or more of existing impervious surface? Circle: Yes (!i•Dlo
FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be
used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the
attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum
Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements.
For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution
Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and
prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction
Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those
that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum
Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan,
principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or
prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual.
APPLICANT SIGNATURE
By signing the Stormwater Calculation 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.
c-E-7 1)/Z
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
FOR OFFICE USE ONLY
SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No
stormwater calc worksheet Rev 9-9-2010—REV 9/9/2010 2
JEFFERSON COUNTY
Cr'? ta
,7 DEPARTMENT OF COMMUNITY DEVELOPMENT--.O r i �I ICI .-
621 Sheridan Street • Port Townsend • Washington 98368
/, �O� 360/379-4450 • 360/379-4451 Fax FEB B 4 2012 �;
$ING http://www.co.Jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBIyIITTA ,M' 1MPLATE,
MLA# l a -a / PROJECT/APPLICANT NAME: 5/1EDJ)OA) gE,S/11=,EA/G6
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. TAte. ZE /S AA EX, -p-i, (a• (A' ,) 301 x 4o ' 6Ate-AG.e bey/ Sc-re
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map. 7 /E LOT /5 1//e2Tu 4 c-c-Y
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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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6. Describe any excess levels of noise generated by the proposed use or activity:
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stormwater site plan template—rev.10/21/2008 5
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.
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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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1 11. Describe the performance goals and standards applicable to the project.
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12. Describe the flow control system.
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stormwater site plan template—rev.10/21/2008 `'
•
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 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. /1//4
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 regu tory agencies. If those permit o.approvals include
conditions that affect the drainage plan or contain more restrictive drakiage-related requirements, de ribe those conditions or
restrictions here. f-F B 1 ,1 2012
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JE PERSON COUNTY
l r T OF COMM.INITY DEVELOPMENT
stormwater site plan template-rev.10/21/2008 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 Volume II Section 3.2.3 of the Manual (beginning
on page 3-7).
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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6. Protect lopes.
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7. Protect Drain Inlets.
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stormwater site plan template—rev 10/21/2008 8
12 Required Elements-Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
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9. Control Pollutants.
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10. Control De-Watering (the act of pumping groundwater or stormwater away from an active construction site).
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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. ; ;i r
a. Descripti n of environmentally sensitive areas that are on or'adjacent to the site.
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JFF1ERON COUNTY
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stormwater site plan template—rev.10/2112008 9
b. Dejis� ription 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., ergdi ility, settleability, permeability, depth, texture, soil structure).
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5. Construction Phasing.
a. Construction sequence
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b. Cons uction phasing (if proposed)
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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 Design Calculations on a separate sheet for the following, if applicable. //4
a. Sediment Ponds/Traps.
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
stormwater site plan template—rev. 10/21/2008 10
SECTION II—EROSION AND SEDIMENT CONTROL PLAN
Sediment and erosion control measures may be depicted on the master land use application plot plan, a stormwater site plan, and/or a
separate Construction SWPPP site plan. This is a checklist to ensure that the following are depicted on a site plan:
1. General.
a. Vicinity Map
b. Jefferson County Approval Block
c. Erosion and Sediment Control Notes
2. Site Plan.
a. Legal description of subject property.
b. North arrow.
c. Indicate boundaries of existing vegetation (e.g., tree lines, pasture areas, etc.).
d. Identify and label areas of potential erosion problems.
e. Identify FEMA base flood boundaries and Shoreline Management boundaries (if applicable).
f. Show existing and proposed contours.
g. Indicate drainage basins and direction of flow for individual drainage areas.
h. Label final grade contours and identify developed condition drainage basins.
i. Delineate areas that are to be cleared and graded.
j. Show all cut and fill slopes indicating top and bottom of slope catch lines.
3 Conveyance Systems.
a. Designate locations for swales, interceptor trenches, or ditches.
b. Show all temporary and permanent drainage pipes, ditches, or cut-off trenches required for erosion &sediment control.
c Provide minimum slope and cover for all temporary pipes or call out pipe inverts.
d. Shows grades, dimensions, and direction of flow in all ditches, swales, culverts and pipes.
e. Provide details for bypassing off-site runoff around disturbed areas.
f. Indicate locations and outlets of any dewatering systems.
4. Location of Detention Best Management Practices (BMPs). Identify location of detention BMPs.
5. Erosion and Sediment Control Facilities.
a. Show the locations of sediment trap(s), pond(s), pipes and structures.
b. Dimension pond berm widths and inside and outside pond slopes.
c. Indicate the trap/pond storage required and the depth, length, and width dimensions. /7
d. Provide typical section views through pond and outlet structure �/ L�
e. Provide typical details of gravel cone and standpipe, and/or of r . ,.r.
f. Detail stabilization techniques for outlet/inlet. ' I
g. Detail control/restrictor device location and details. 1 r., I
h. Specify mulch and/or recommended cover of berms and slopesf F E B ` [`I ij
i. Provide rock specifications and detail for rock check dam(s), if pplicable.
j. Specify spacing for rock check dams as required. u'
JEff ERSON COUNTY
k. Provide front and side sections of typical rock check dams. PFDT „ r • ;;ITY t;;. n,rTof^ENT
I. Indicate the locations and provide details and specifications for fabric.
m. Locate the construction entrance and provide a detail.
6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained and
illustrated with detailed drawings.
7. Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other than
sediment(e.g.,concrete wash water).
8. Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for monitoring water quality on
the construction site. Sampling stations should be located upstream and downstream of the project site.
stormwater site plan template—rev.10/21/2008 11
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.
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(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
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