HomeMy WebLinkAboutBLD1995-00600 THIS BUILDING IS
NOT FINALED .
THIS IS AN INCOMPLETE
BUILDING APPLICATION . THE
PERMIT WAS NEVER ISSUED .
JEFFERSON COUNTY BUILDING APPLICATION
Jefferson County Permit Center
Castle Hill Mall
621 Sheridan St.
Port Townsend, WA 98368
360-379-4450
PERMIT # •BLD95-0600 DATE RECEIVED. : 10/05/95
SITE ADDRESS: 5923 DOSEWALLIPS RD
:BRINNON, WA 98320
APPLICANT. . . :TOM JAHNS PHONE:
MAILING ADDR: 5923 DOSEWALLIPS RD
:BRINNON WA 98320
CONTRACTOR. . :OWNER PHONE:
MAILING ADDR:
•
CONTR. LIC #: EXPIRATION DATE: / /
ARCHITECT/ . . : PHONE:
DESIGNER
MAILING ADDR:
PARCEL NO. . . : 603243006 ALT: y- CON : A
LEGAL DESC. . : STR 24-26- Z WWM, TAX # BY : ma`J DATE: /
LOT , BLOCK ,
WATER: DATE:
CAR
: !�'��.. DATE. i//?��,!
DESCRIPTION OF IMPROVEMENT: Single family residence
BUILDING TYPE •RES BEDROOMS--- BATHROOMS-- MAIN FL. . . : 512 sf
TYPE OF IMPROVEMENT:NEW EXIST. : 2 EXIST. : 1 ADD'L FL. . : 256 sf
GARAGE/CARPORT • PROP. . : 0 PROP. . : 0 HTED BSMT. : 0 sf
WOODSTOVE • TOTAL. : 2 TOTAL. : 1 UNHT BSMT. : 0 sf
UBC OCCUPANCY GROUP: SEWAGE DISP. . : SEPTIC OTHER • 0 sf
TYPE OF CONST • WATER SUPPLY. :PWELL CRPT/GAR. . : 0 sf
UNITS. : 0 STORIES: 2 HEAT TYPES. :WOD/ / DECKS • 250 sf
DIMENSIONS: MOBILE HOME COMMERCIAL: 0 sf
FRAME TYPE:WOOD MAKE: YR: INDUSTRIAL: 0 sf
EST COST. $: 40822 SIZE: BANK HT. . . : 10 ft
PROJ GRP. . : 7088 SH SETBACK: 105 ft
Owner/agent FEES
Signature: type amount by date recpt
PRMT $ 493 . 75
ite: PLCK $ 148 . 12 112 6°
B.C. $ 4 . 50
Sued By: /41819f
PA'
$ 646. 37 TOTAL
41)
JEFFERSON COUNTY PERMIT CENTER, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 r
BUILDING PERMIT APPLICATION — 51995
PROJECT DESCRIPTION: 5 i '1 L_—
C% t (�y 0(,�)Q I i I 6'1�
y- e'6
CZ;, Ste, 9
BUILDING SINGLE FAMILY P IEW TYPE: FR TYPE:
WOOD
❑ GARAGE ATTACHED/DETACHED ❑ ADDITION ❑ STEEL
❑ MODULAR ❑ ALTERATION/REMODEL ❑ CONCRETE
❑ COMMERCIAL ❑ REPAIR ❑ MASONRY
I
El MULTI FAMILY/# OF UNITS ❑ DEMOLITION El OTHER
❑ INDUSTRIAL
❑ OTHER
BEDROOMS: BATHROOMS: TYPE OF SEWAGE DISPOSAL:
EXISTING 2 EXISTING I ❑ SEWER ❑ COMMUNITY SYSTEM
PROPOSED PROPOSED INDIVIDUAL SYSTEM C9/Conventional
TOTAL 2,. TOTAL I PERMIT # SEP gc"ZI`7 ❑ Alternative
WOCte.,r _' ..a ''iC, �,.sfctlltcJ ` ekppCoifed acf06cte !9c11:
WAR SUPPLY: TYPE OF HEAT:
1W PRIVATE WELL El ELECTRICITY ❑ OIL
❑ PUBLIC Name of water system: D'..-WOODSTOVE ❑_.....PROPANE
❑ HEAT PUMP L� OTHER:
(,cr ys.i c.,e. S 6Ie t-
SQUARE FOOTAGE: _
MAIN FLOOR 3 / L, j Sy
2ND FLOOR 25C
/ �l --7 7 FOR OFFICE USE ONLY
3RD FLOOR UBC OCCUPANCY GROUP
HTD BASEMENT
UNHTD BASEMENT
CARPORT BASE FEE / �1 / J
GARAGE /� PLAN CHECK /'/
DECKS J. pS J d�� STATE SURCHARGE 4.50
COMMERCIAL . . ,,/ ` :
TOTAL `7 fe'. ° >
INDUSTRIAL
OTHER y�77
TOTAL VALUATION RECEIPT tt' //i 0�
or 1 5" a CAS O'/ cK
ESTIMATED COST 7C �� - '''
1J DATE )0f i / ;
IF WATERFRONT PROPERTY, 35°-30 ° S h. per~
DISTANCE TO BANKK OR HIGH WATER L E IO5 IUD ft BANK HEIGHT /04ft
SIGNATURE - li'le` re ` ,/ Z DATE 9//4/
/5-
NAME (PLEASE PRINT) J I1/ d4 11 1*G � H:\Home\Plncntr\Forme\Bldapp.Fm 8/95
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` (2)) CRITICAL AREA STANDARD WAIVER
APPLICANT: TOM JAHNS
5923 DOSEWALLIPS RD
BRINNON WA 98320
CRITICAL AREA REVIEW CASE NO. CAR95-0126
PARCEL # 603243006
PROJECT DESCRIPTION: Single family residence
FINDING: The development, as proposed and portrayed on the
Universal Plot Plan, does not encroach on an
identified critical area nor any associated buffers.
CONCLUSION: The proposed development meets the waiver
requirements established in Jefferson County
Ordinance 05-0509-94 .
CONDITION: The development shall be as proposed and portrayed
on the Universal Plot Plan. Deviation, additions or
relocation of proposed development activities will
require further review pursuant to the Jefferson
County Critical Areas Ordinance.
November 9, 1995
1
For Ecology Use
"°' ""' State of Washington F� Paid
oar ri .i + °i
F (� 0 l n G Y
Application for a Water Right Date
Please follow the attached instructions to avoid unnecessary delays.
Section 1. APPLICANT - PERSON, ORGANIZATION, OR WATER SYSTEM.
Name 11100145 Y Dar1e vie. et-k h S Home Tel:( ) IU �
Mailing Address 5123 Dose=Loath+ C've r' 1 ocid Work Tel:( ) /?J
City (3rlrroJ1 State ' /3 Zip+4 9i 32.O +966 / FAX:( ) /(Jot1/2
Sec ' n 2. CONTACT- PERSON TO CALL ABOUT THE APPLICATION
Same as above
Name Home Tel:( ) -
Mailing Address Work Tel:( ) -
City State Zip+4 _+ FAX:( ) -
Relationship to applicant
•
Section 3. STATEMENT OF INTENT
per minute or allons
The applicant requests a permit to use not more than �� ( L�g p
❑ cubic feet per second) from a urface water source or ❑ ground water source (check only one) for the
purpose(s) of tipvnesi-tc. ( it"Ie, fa.>n.ily hovS�halet JS�) Attach a "legal"
description of the place of use. (See t structions.) NOTE: A tax parcel number or a plat number is not sufficient.
Estimate a maximum annual quantity to he used in acre-feet per year: 0
❑ Check if the water use is proposed for a short-term project. "•is•';- I„ , • V E ,. at the water will be
needed:
From / / to / /
FEB 14 r-'` 3
Section 4. WATER SOURCE
JEFFERSON COUNTY
PERMIT CENTER
If SURFACE WATER If GROUNDWATER
Name the water source and indicate if stream, spring, A permit is desired for well(s).
. lake, etc. If unnamed, write "unnamed spring,"
"unnamed stream," etc.: , 0
``on no,,w d spy'►t"9
Number of diversions: on 'C,,
Source flows into (name of body of water): Size & depth of well(s):
LOCATION
Enter the north-south and east-west distances in feet from the point of diversion or withdrawal to the
nearest section corner:
50 Saab. a -5: west 5&. eozAnzl, sec ,,. -
If'location of source is p latted, complete
below:
'/, of '/ of Section Township Range(E/W) County
Lot Block Subdivision
A1 �'lq Me/9 25 2.1U -3 W 94_6(ecscv.,
For Ecology Use Date Received: Priority Date: ,
SEPA: Exempt/Not t/Not Exempt FERC License Dept. Of Health #
Date Accepted As Complete By Date Returned By WRIA:
L ECY 040-1-14 APPLICATION
Rev. 12/94 F Appl. No.:
•
J /
Section 5. GENERAL WATER SYSTEM INFORMATION
A. Name of system, if named:
B. Briefly describe your proposed water system. (See instructions.) 3 per-ford-cc)
tead1Mq? 6octItiQc masov+q
�rtrJzv. tw'tDypr■n�� lead►h� t0 O�- pt�, /
w
seff.h r9 +auk wjo)e,rflou) ftpe ) dea soot fa vice t c&vid tJXrtrh9
pip 1eaa "- '6c h . 6-y-eko -1 etz Qd systerv. . ttll Que.(flow
in-to drainay • CO a sertJa-f-,an m_e.asvres
1,iU n arx.y —cu (€4421/ os.e, /ess
*evil IO 9 !!an Watt pev day t►, tf,ve_
Pore s/ '►Py 'vow
is save d f✓ u, . U
C. Do you already have any water rights or claims associated with this property or system? ❑ YES 1137NO
PROVIDE DOCUMENTATION.
Section 6. DOMESTIC / PUBLIC>WATER SUPPLY SYSTEM INFORMATION
(Completed for all domestic/public supply uses.)
A. Number of "connections" requested: C71'l.Q, Type of connection ipi
( omes, Apartment, Recreational etc
B. Are you within the area of an approved water system? ❑ YES 0
If yes, explain why you are unable to connect to the system. Note: Regional water systems are identified by
your County Health Department.
Complete C. and D. only if the proposed water system will have fifteen or more connections.
C. Do you have a current water system plan approved by the
Washington State Department of Health? ❑ YES ❑ NO
If yes, when was it approved? Please attach the current approved version of your plan.
D. Do you have an approved conservation plan? ❑ YES ❑ NO
If yes, when was it approved? Please attach the current approved version of your plan.
Section 7. IRRIGATION/AGRICULTURAL/FARM INFORMATION
(Complete for all irrigation and agriculture uses.)
A. Total number of acres to be irrigated:
B. List total number of acres for other specified agricultural uses:
Use Acres
Use Acres _
Use Acres 4
r
C. Total number of acres to be covered by this application: JEFFERSON COUNTY
PERMIT CENTER
D. Family Farm Act (Initiative Measure Number 59, November 3, 1977)
Add up the acreage in which you have a controlling interest, including only:
$ Acreage irrigated under water rights acquired after December 8, 1977;
t Acreage proposed to be irrigated under this application;
1 Acreage proposed to be irrigated under other pending application(s).
1. Is the combined acreage greater than 2000 acres? 0 YES 0 NO
2. Do you have a controlling interest in a Family Farm Development Permit? ❑ YES 0 NO
If yes, enter permit no:
E. Farm uses:
Stockwater - Total # of animals Animal type (If dairy cattle, see below)
Dairy - # Milking # Non-milking
• APPLICATION
F
Section 8. WATER STORAGE
Will you be using a dam, dike, or other structure to retain or store water? 0 YES k/NO
NOTE: If you will be storing 10 acre-feet or more of water and/or if the water depth will be 10 feet or more at the deepest point,
and some portion of the storage will be above grade, you must also apply for a reservoir permit. You can get a reservoir permit
application from the Department of Ecology.
Section 9. DRIVING DIRECTIONS
Provide detailed driving instructions to the project site. F r, 13 r.t n h tm , (414 , •f die,
Dose wa0 tp s Rt x?-r Road av,.) roc,ae-& Viz- wt tI.e.s
(� P ) 1-v r n
.1 etf 071 tx.e, qv-ewe-1 Forest Sc eJsc-e. RoGd eib, Proceed i)g
111`11e. to b n'd9 e, UC-V )f.5 Dose-u.xt(1 t(2c RIue-r, pa(/c 8y 6 ridye-,
RQ-6;dehce. o'vt )e++ s :de- o-E- read , D,uers,o ZZD feet i.,9 Rdoez
/e Pt- side,,
Section 10. REQUIRED MAP
A. Attach a map of the project. (See instructions.)
/
Section 11. PROPERTY OWNERSHIP
A. Does the applicant own the land on which the water will be used? AYES 0 NO
If no, explain the applicant's interest in the place of use and provide the name(s) and address(es) of the
owner(s):
•
@ tl N
JEFFERSON COUNTY
S.
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Jefferson County Permit Center ' :1 Date
621 Sheridan Street Fee
Port Townsend WA 98368 f; t Rec #
E
CRITICAL AREAS QU NAIRE Ck #
Case #
Applicant Name ® Ci>11 c' ,. ,(tft iiltii' et. 1t a
_�Building Application Land Use Application _ Shoreline Application
On-site Sewage Application _ Subdivision Application _ Other:
1 . Is there any standing or running water on the surface of the YES NO
property or on any nearby property at any time during the year?
If YES, please describe: py-96.e", (AU 10 c-ateel 0)'1--- --tike.,'
o cet kd l t s K' Ar
1� ( GI , l)is D f a411.4;7 in) 41.4.4,t,14.441 tor eiTte.,z,
2. Has any portion of the property or any nearby property ever been YES 4---(10
identified as a wetland or swamp?
If YES, please describe:
3. Are any willows, skunk cabbage, alders, or cottonwoods present YES NO
on your property or adjacent properties? ,
If YES, please describe: indclis . Rw '_ !v 0 (,U Iflows ?
5k())/1k C6\60xx ) Oli CJ` .
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4. Are there any indications on any portion of the property or on any YES NO
nearby property of rockslides, earthflows, mudflows, or landslides?
If YES, please describe:
5. Please indicate which line best represents the steepest slope found
on your property. (Check appropriate box)
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6. Does the site have steep slopes with little to no vegetation? YES NO
If YES, please describe:
7. Does the site contain high percentages of silt and/or very fine YES /NO
sand?
If YES, please describe:
8. Does the site contain ground water seepage or springs near the YES NO
surface of the ground?
If YES, please describe: 1 5 Yl 11 2 Z cwt ra.47„,
GL 3 O � /`v i la s crz. , 70, 0.02.E
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The applicant hereby certifies that all of the above statements and the information contained in any other
transmittals made herewith are true, and the applicant acknowledges that any action taken by Jefferson
County based in whole or in part on this application may be reversed if it develops that any such statement
or other information contained herein is false.
Signature 2 I ` �{�44. Date /(1)41/95-
FOR OFFICE USE ONLY
❑ Wetlands ❑ Seismic
CRITICAL AREAS ON OR ❑ Atiuifer Recharge Area (zone_) ❑ Fish & Wildlife Area 1
IMMEDIATELY ADJACENT TO SITE: ❑ Frequently Flooded Area ❑ Fish & Wildlife Area 2
❑ Erosion
El Landslide
Zone:
Parcel Size: Status:
Comprehensive Plan Land Use Designation: Reviewed by:
Community Plan: Date: