HomeMy WebLinkAboutBLD2006-00361 - CANCELLED •
BUILDING PERMIT .�
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD06-00361 Received Date 06/27/2006
SITE ADDRESS: 195 SPIKE LN Issue Date 08/3/2006
FORKS, 98331
APPLICANT: SUZANNE M ZALOKAR PHONE: (360) 374-0390
EDMUND C ANSORG JTWROS
PO BOX 1661
FORKS WA 98331-1661
SUBDIVISION: Block: Lot: +
PARCEL NUMBER: 612042003 Section: 4 Township: 26 N Range: 12 W
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: NEW SFR W/UNINSULATED SUNROOM
ALSO A/G 50 GAL PROPANE TANK
CALL IN FOR THE REQUIRED INSPE TI S THAT PPLY TO YOUR PROJECT.
SETBACKS: - .�.:; �L DOC,
UFFER: f�Footing: y( i AL/,
Foundation:
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall :
Sheathing:
Framing: Uyir)e: FLVR FRAMtNL&- 10.1. 0(.9
Plumbing:
Propane Tank/ Lines:
Insulation:
Sheetrock:
Septic Sytem Final Approval MUST be obtained before final of structure can be attempted.
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval:
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTIO
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTir
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY -SEE REVERSE
•
SPECIAL CONDITIONS FOR CAllit BLD06-00361
1.) A"Construction Drawing" Flood Elevation Certificate was prepared by a licensed surveyor
and submitted with the application. The Certificate identified the base flood elevation of
151.12 feet. The lowest floor of the structure is required to be elevated at least one (1)
foot above base flood elevation or 152.12 feet. PRIOR TO FINAL BUILDING
INSPECTION, PROPONENT SHALL PROVIDE THE DEPARTMENT WITH AN
ORIGINAL "FINISHED" CONSTRUCTION" FLOOD ELEVATION CERTIFICATE THAT
HAS BEEN VERIFIED BY A LAND SURVEYOR, ENGINEER, OR ARCHITECT
AUTHORIZED BY LAW TO CERTIFY ELEVATION INFORMATION IN THE STATE OF
WASHINGTON.
2.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater,
erosion and sediment during construction. BMPs shall address permanent measures to
stabilize soil exposed during construction, and in the design and operation of stormwater
and drainage control systems.
3.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP)
Elements#1 through#12 of the Department of Ecology's Stormwater Management
Manual for Western Washington to control stormwater, erosion and sediment during
construction. BMPs shall address permanent measures to stabilize soil exposed during
construction, and in the design and operation of stormwater and drainage control systems.
4.) Stormwater shall be retained and infiltrated on site. The owner shall control all
sedimentation and erosion on the property.
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 two (2) unlicensed or inoperable vehicles shall be stored on any lot less
than one-half acre 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 Unified Development
Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable
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 of the UDC,
and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any
such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area
(ESA).
7.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
8.) Setback from Spike Lane right-of-way is no less than 20 ft., setback from Nansen
Anderson Rd. Ext. right-of-way is no less than 20 ft., side and rear setbacks are no less
than 5 ft. If an environmentally sensitive area (ESA) is present, then the more restrictive
setback shall apply.
9.) 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.
10.) 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.
11.) The building height is not to exceed 35 feet.
12.) A minimum of two (2) on-site parking spaces is required for the single-family residence.
13.) Construction Materials and Methods of Construction to Reduce Flood Hazard
(i)All new construction and substantial improvements shall be constructed with materials
and utility equipment resistant to flood damage.
(ii)All new construction and substantial improvements shall be constructed using methods
and practices that minimize flood damage.
(iii) Electrical, heating, ventilation, plumbing, and air-conditioning equipment and other
service facilities shall be designed and/or otherwise elevated or located so as to prevent
water from entering or accumulating within the components during conditions of flooding.
Locating such equipment below the base flood elevation may cause annual flood
insurance premiums to be increased.
•
14.) New construction and substantiaTimprovement •
of any residential structure shall have the
lowest floor, including basement, elevated one foot or more above the base flood
elevation (BFE).
15.) Flood proofing measures are to be used as required by the Jefferson County Flood
Damage Prevention Ordinance 07-0515-06 (Jefferson County Code Chapter 15.15).
16.) 1) All new construction and substantial improvements shall be anchored to prevent
flotation, collapse, or lateral movement of the structure.
2) All manufactured homes shall be anchored to prevent flotation, collapse, or lateral
movement, and shall be installed using methods and practices that minimize flood
damage. Anchoring methods may include, but are not limited to, use of over-the top or
frame ties to ground anchors.
17.) Fully enclosed areas below the lowest floor that are subject to flooding are prohibited
unless designed to automatically equalize hydrostatic flood forces on exterior walls by
allowing for the entry and exit of floodwater. Designs for meeting this requirement must
either be certified by a registered professional engineer or architect or must meet or
exceed the following criteria: a. A minimum of two openings having a total net area of not
less than one square inch for every square foot of enclosed area subject to flooding shall
be provided. b. The bottom of all openings shall be no higher than one foot above grade.
c. Openings may be equipt with screens, louvers, or other coverings or devices provided
that they permit the automatic entry and exit of floodwater.
18.) Utilities shall be designed as specified in 15.15.080(c) of Jefferson County Flood Damage
Prevention Ordinance 07-0515-06 (Jefferson County Code Chapter 15.15) which states:
(i)All new and replacement water supply systems shall be designed to minimize or
eliminate infiltration of flood waters into the systems; (ii) Water wells shall be located on
high ground that is not in the floodway; (iii) New and replacement sanitary sewage
systems shall be designed to minimize or eliminate infiltration of flood waters into the
systems and discharges from the systems into flood waters; (iv) Onsite waste disposal
systems shall be located to avoid impairment to them or contamination from them during
flooding.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
1011
(JILDING PERMIT APPLICAT N MRAOWOO Type:
I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00361 Received Date: 6/27/2006
SITE ADDRESS: 195 SPIKE LN
FORKS, 98331
OWNER: SUZANNE M ZALOKAR PHONE: (360) 374-0390
EDMUND C ANSORG JTWROS
PO BOX 1661
FORKS WA 98331-1661
SUBDIVISION: Block: Lot: +
PARCEL NUMBER: 612042003 Section: 4 Township: 26 N Range: 12 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr NEW SFR W/UNINSULATED SUNROOM
ALSO A/G 50 GAL PROPANE TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 936
VALUATION 76,375.00 ADD'L: HEAT TYPE: PRO
CODE EDITION: 2003 HEAT BASE: HEAT TYPE: WOD
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: 648 SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 2 Prop: 1
Total: 2 Total: 1
/Routing Date: IP /No Ci"3
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $832.75 KAS 06/27/06 83592
Plan Check $541.29 KAS 06/27/06 83592 A
State Building Code $4.50 KAS 06/27/06 83592 AUG 3 2006
Potable Water Application $55.00 KAS 06/27/06 83592
Total: $1,433.54 jefff rsc ' •rictitii4
Buil6,ny i:tmartment
'4. , .
(945oN c�G C�N JEFFERS COUNTY
W ` \g ,4' DEPARTMENT OF COMMUNITY DEVELOPMENT
`4 621 Sheridan Street• Port Townsend • Washington 98368 JUN 2 7 2006
360/379-4450• 360/379-4451 Fax
4q�, N0 9 www.co.jefferson.wa.us/commdevelopment ((pp((++ WW (+
.� rr[RJl,9 C r �'.
Master Permit Application ,LA: ' '''
Project Description(include separate sheets as necessary): ,�� ' I •
f i fu, 5 i rl 3 -mom U t re31 c)14-yo -.
Tax Parcel ,,- Property Z
Number. (c, (2 LL•ZCc. Size: Co,,QCr u07//zLCt-CZ�acreslsquare feet)
Site Address and/or Directions to Property: /93— 5 P/KC" LaAivC F-t eKS LA�,1,G�. q ..33 1
Owne
r(s) 50E- Z�(...0k/42 / rG t� AN%c�;ZC_
Telephone: T c)- .3/L/ - O73 ci t3 Fax:
email: FbeKSPAiVIlir-iC :4410�l,Lt`e-1
Mailing Address: PO iC)( I���-1 �U i�-K S „�' k j j
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
Building 0 Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C)*"
Single Family 0 Discretionary"D"or Unnamed Use Classification
❑ Garage Attached/Detached 0 Special Use(Essential Public Facilities)**
El Manufactured Home 0 Boundary Line Adjustment
❑ Modular 0 Short Plat"
El Commercial* ❑ Binding Site Plan**
❑ Change of Use ❑ Long Plat**
Cl Address I Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
Propane ❑ Plat Vacation/Alteration**
❑ Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
y—.Stormwater Management ❑ Shoreline Management Substantial Development**
0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance
0 Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre—Application Conference **Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or 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.s Access and right of entry to this property shall be requested and shall occur only during regular business
Signature:
6 c L� / - .44j�...�r�
Si nature: l( c` / 0 G
Date:
f
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_ re onsi lity for adhering to nd complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: 1_ Date:
�- / v 6;
C:\Documents and Settings\mocha\Desktop\Master Pennit Application 7-8-04.doc
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1
OWNER 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: C�'V lr i--) �''�`� Date �S 'C "(,.
i
R3s`CiitliVIF,D
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
J
( ) }f(J( ) }�
MAILING ADDRESS: EMAIL: U{i 2 7 (�(�L&
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER �Er ARCHITECT/ENGINEER: PHONE ( ) SiCU U N ii IJ L I I
MAILING ADDRESS: EMAIL
—
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New k Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: i Bank LI Community System
❑ Alteration/Remodel CI Concrete Total: __ Height: Individual System
❑ Repair p Masonry !'r' SEP Permit# ci•-cni2.7
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: >g, Private well [l Two Party
Type of Heat: Proposed: 'Z LI Public
pc
Total: Z
t�.t1� vl I, Name of System:
i
tNt^ ':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 bove ground Tarr. Size of Propane Tank: 5(' C ALL Cr.I
(-lest Stove)(Cook Stogy I oodstovee , I Fireplace Insert i(1:19t Water Tank) I Pellet Stove i Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes T 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 For Office Use Only EUSE'P/VZF,lKrc.V (o5.c()
Current Proposed Amount
Main Floor Consistency Review:
f3( �� 1�a. 153113
2"u Floor Base fee: �,
3°Floor Additional Section: -t..=C
Mezzanine: Plan Check fee: _5� -yy
Heated Basement State Surcharge fee: 50
Unheated Basement Pot Water Review fee:
qD.OD
Other Unheated 911iRd Approach fee:
NILtSkt.�
Garage/Carport
TOTAL: $ 1 _ . C�
Decks
(( y.� ` _ lD u
; 5 a�3 eceipt Q t Number:
Other Cash/Check Number: k Is '
ESTIMATED COST(REQUIRED) Date: I \
.Fair market value of all labor and materials foundation toto ' [,
at Z 000 (-___.1 ce l5• Tlnitials:
C:\Documents and Settings\mochit\Desktop\Master Permit Application/8-b4.doc
APPROVED
• • STORMWATER PLAN
ioON
JEFFERSON COUNTY Jut 3 1 20C4
terliki;11",
74 DEPARTMENT OF COMMUNITY DEVELOPMENT
JEFFER N CO NTY
621 Sheridan Street - Port Townsend •Washington 98368 Om
6*- Y 3 0/379-4450 360/379-4451 Fax SIGNATURE:
149Zinsil
http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# Oct)- PROJECT/APPLICANT NAME: S ZAt-L,te.-At. ek)
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 stomiwater 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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6. Describe any excess levels of noise generated by the proposed use or activity:
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JEFILIISON COUNIY HCIJ
storrnwater site plan template-rev 1(V1/2003 5
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4 7: Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams,
steep slopes,etq.)on the ite. 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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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.
9. 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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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.10/1l2003 6
• • •
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.
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. a 3 -,
It'
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
N/A , , , ,,, 77 7 up
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.
wiit.
stowatersitepianterrptate—rev,tOJtt2t]43 JEfTEO'SON COUNTY DC1a
mr 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 section 2.5.2 of the Manual(beginning on page
2-15).
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.
4. Install Sediment Controls. _
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5. Stabilize Soils.
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6. Protect Slopes. � , `, :� .
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. Protect Drain Inlets. - Cftifir'
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stormwater site plan template—rev.1LY1/2003
. .
• •
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),
4ct:.) •
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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.
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a. Description of environmentally sensitive areas that are on or adjacent to the U.ff S
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storrnwater site plan template-rev 10,11/20a3 JEFFERSON COUNTY BCD 9
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• •
b. Description of special requirements for working in or near environmentally sensitive areas.
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).
t¢I. Pr„oovideja proposed construction schedule. .,jj '('�
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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.
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
,,may
impacts. fl3 : fig 3
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8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps.
b. Diversions.
c. Waterways. INJ/1k
d. Runoff/Stormwater Detention Calculations
10
stormvrater site plan template—rev.10/1/2003
J r
• •
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 AUTHORIZE6 RkPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
t
m lhSC} l COUNTY O
stormwater site plan template-rev.10/112003 12
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