HomeMy WebLinkAboutADR2009-00072 .
RECEIVED
A
ADDRESS REQUEST
JEFFERSON COUNTY PERMIT CENTER JUL 2 j 2009
621 Sheridan, Port Townsend, WA 98368 (360) 379-4450
APPLICANT: Please fill out item 1 through 8. Fee as per Jefferson CoytaftiffiftycthttRity 0 c
1. New Address Correction ❑ Change El Review DIFF LEFT M.P. RIGHT DIFF
2. Applicant Name: L.Q(aRI E., 1=2:1 LC/
3. Mailing Address: 2.L ��yyPORT Yv Y N\i
Town/State/Zip `Smts% }} WA
9 .4173
4. Telephone: Work 1: 5..<91.94 Home: 557_0746
5. Location: Attach a Detailed Drawing or Map.
Additional Fees May Be Required if More Than One
Site Visit Is Necessary
*******PLEASE FLAG YOUR DRIVEWAY.*******
Date Flagged:7 /( /0 Flagging Color C..l
Nine Digit Tax Parcel Number 962 7001. 1a
Plat Name Block Lot 63
6. Road Na le
Is this a 'RIVATE br COUNTY road? CIRCLE ONE
i
Nearest Cross Road: it_ . .. s
7. Neighbors' Address if Known:
Name/Address:
Name/Address:
8. Do You Ne��•• To Construct a Driveway?
YES or <i1'r CIRCLE ONE
FIELD NOTES
9. Was This emitted With A Building Permit?
YES or NO CIRCLE ONE
SHADED AREAS OFFICE USE ONLY /
New Address: ✓
] G race nd I/1 �� _,7
Postal District: Por4 foe
Real Milepost: • 17 Road#:
Left ght Fire District Building Permit# date Sent 8
4' Odd Even Date Paid 1 1c1,0 1 Check# 3 Q aLt Receipt# J Q 1� Date in Computer S-1 It
1Z2.i3T�
-ls.ol
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
ADDRESS REQUEST INSTRUCTIONS
o Complete the address request form in as much detail as possible. The most important
information to include is the complete name of the road where your property is located,
whether or not the property is in a plat, the nine digit parcel identification number and
the block/lot number. The fee is $2 i 3
o You must also attach a vicinity map or drawing.
o Use the survey ribbons provided to flag both sides of your driveway. If your driveway is
not in yet, mark the location where the driveway will be. You must apply for a road
approach permit if your driveway will connect with a county road.
o The address technician from the Permit Center will assign your address within 5 working
days. The technician will visit the site and determine the address according to the
nearest milepost distance from the start of the road.
o The red address plate will be sent to your current mailing address, as indicated by you on
the address request form, within one week to ten days. The plate is to be posted at the
end of your driveway and is to be clearly visible from both directions.
o The Permit Center will notify the appropriate postmaster, fire district and emergency
services of your new address.
****************************************************
ROAD APPROACH INSTRUCTIONS
o If you are constructing a driveway that will connect with a county road, you must apply for
a road approach permit. The fee is $21 3 —
o To complete the application for the permit, you will need to indicate the nature of work
and to include a simple sketch of the proposed work. You will also receive a survey
ribbon to mark the site.
o Once the permit inspector has visited the site, a permit will be drawn up and will include
the general conditions as well as any specific requirements concerning your site.
o The permit will be sent to you for you to read and sign. You are then asked to return the
permit to the Permit Center for the permit inspector to sign. You will receive a copy of the
signed permit. The permit is valid for a period of one year.
IF BOTH THE ADDRESS REQUEST AND THE ROAD APPROACH PERMIT IS APPLIED FOR
AT THE SAME TIME, THE TOTAL FEE $- :_c3 —
If you have additional questions,call the Department of Community Development at(360) 379-4450.
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PLEASE ATTACH A MAP OR DRAW A DETAILED SKETCH
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APPLICATION FOR ROAD APPROACH PERMiT
Jefferson County Permit#
Department of Community Development Receipt#
621 Sheridan Street Check#
Port Townsend, WA 98368 Date Paid
(360) 379-4450
APPLICANT PLEASE PRINT OR TYPE ALL INFORMATION - CHECK BOXES THAT APPLY
0 Residential Approach Logging Approach El Temporary
0 Commerical Approach 0 Improvements Only n Approach&Address
County Road Name: Mile Post#:
(office use only)
I hereby designate
Applicant or Authorized Representative (Contractor) to act as my agent In matters related to this
Contractor Lic.# application for permit(s).
Mailing Address Owner Signature Date
City-State-Zip Code Parcel Number
Telephone No. Flagging Color&Date
ACKNOWLEDGEMENTS
By signing the application form,the applicant attests that the information provided herein is true and correctto the best of their knowledge
and agrees to al conditions on the permit. I also certify that tis application is being made with the full knowledge and consent of all owners
of the affected property. Any material falsehood or any omission of material fact made by the applicant/owner 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 Iiablitles,judgment,coat costs,reasonable attorneys 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 inspection. This right of entry shall expire when the County concludes the application has complied
with all applicable laws and regulations. Access and right of entry to applicant's property shall be requested and shall occur only during
regular business hours.
The action or actions Applicant will undertake as a result 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 and complying with the ESA.
The Applcant has read this disclaimer and signs and dates it below.
(APPLICANT OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
Updated 2/12/2008
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TO (/Qk i DATE p TIME/;Y (� AM
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FRO `��%j V' �p �- AREA CODE 626e....."
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PHONED❑ BACK CALURNED D SEE YOUO ❑ AGAIN ALL ❑ WAS IN URGENT T 0
7/7/2009
, �� Conditions Associated With 307:21PM
'7\ Case #: RAP07-00139
Condition Status Updated
Code Title Hold Status Changed By Tag Date By
1 000 CULVERT 12" None NOT MET 8/22/2007 TLD
A minimum 12 inch diameter culvert,not to exceed 30 feet in length,to accommodate a 10 to 16 foot wide driveway
with 25 foot approach radius is required. If more than one culvert is used,both culverts must be made of the same
material and be connected with an approved band.
1010 SIGHT BRUSHING None NOT MET 8/16/2007 TLD
The applicant shall be responsible for maintaining all vegetation on their property to maintain the minimum sight
distance requirement for this location.
1019 CRUSHED SURFACING None NOT MET 8/16/2007 TLD
The applicant must place a minimum of 2 inches of crushed surfacing to the right-of-way line.
1037 SURFACE WATER None NOT MET 8/22/2007 TLD
The grade of the approach shall follow the crown of the road to the ditch line, and be no greater than 2%for 20 feet from
the edge of pavement and,be such that all surface water shall be directed into a ditch line and not onto the county road.
1070 FINAL INSPECTION None NOT MET 8/16/2007 TLD
The Applicant must contact the Public Works Department for a final inspection prior to a final building inspection.
9140 P-PRIVATE ROAD APPROACH None NOT MET 8/22/2007 TLD
The Applicant may install a private road approach to Graceland Way at mile post.17 right.
Page 1 of 1 CaseConditions..rpt
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APPLICA fCtR ROAD APPROACH PERMIT
Jefferson County k � Permit #
Department of Community Development i, ! JUN 2 9 ,v Receipt#
621 Sheridan Street U '"" Check#
Port Townsend,WA 98368 J Date Paid
(360) 379-4450 or 1-800-831-2678
APPLICANT PLEASE PRINT OR TYPE ALL INFORMATION CHECK BOXES THAT APPLY
Residential Approach 0 Logging Approach [] Temporary
❑ Commerical Approach LI Improvements Only I x I Approach&Address
County Road Name: GRAC.€L A-N p WAY Mile Post#: 0 •. I'-1 - ---
(office use only)
I hereby designate 17Ar.4epA RIGS
1
Applicant or Authorized Representative(Contractor) to act as my agent la matters related to this
Contractor Lic.# application for permit(s).
1/ IlbAir64 W.4 id lit/ 4 AtetJ P.4—A -1-2 c y
Mailing Address Owner Signature Date
City-State-Z Code Parcel Number
4 1 NS. 4 n ^
Telephone No. Flagging Color&Date
ACKNOWLEDGEMENTS
By signing the application form,the applicant attests that the information provided herein Is true and correct to the best of their knowledge
and agrees to a1 conditions on the permit. I also certify that this application is being made with the full knowledge and consent of all owners
of the affected property. Any material falsehood or any omission of material fact made by the applicant/owner with respect to this application
packet may result in this permit being null and void.
I further agree to saw,indemnify and hold harmless Jefferson County against all liablities,judgment,court costs,reasonable attorney's fees
and expenses which may In any way accrue against Jeffers on 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 Inspection. This light of entry shall expire when the County conckidesthe application has complied
with all applicable laws and regulations. Access and right of entry to applicant's property shall be requested and shall occur only during
regular business hours.
The action or actions Applicant wil undertake as a result 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 regardingyour
action(s)even if you are in compliance with the Jefferson County Development Code
e Applicant acknowledges that/'e,she or It hi, individual and non-transferable responsibility for adhering to and complying with the ESA.
e Appicart has read this dscl.finer and si. s d dates it below.
/AITLICANT r •UTHr• • • PR VE SI TORE � e� ,
(DATE)
Updated 2/12/2008
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