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Home My WebLink AboutADR2008-00068 ADDRESS REQUEST JEFFERSON COUNTY PERMIT CENTER 621 Sheridan,Port Townsend, WA 98368 (360) 379-4450 APPLICANT: Please fill out item 1 through 8. Fee as per Jefferson County Fee Schedule "CZ Address El Correction ❑ Change ['Review DIFF LEFT M.P. RIGHT DIFF 2. Applicant Name: AniZZ l�iY 3. Mailing Address: // GLi ! 9t5-X ,Town/ State/Zip a24 Ki' /t ? , { of 4. Telephone: Work A. b 66 Home:762-- 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: / 08 Flagging Color rGUG Nine Digit Tax Parcel Number --7c>// $ ` C Plat Name H Block Lot 6. Road Name: e. G c.t is this a PRIVATE or 1 LB s d? CIRCLE ONE Nearest Cross Road: , , /( G-r ca t` 7. Neighbors' Address if Known: Name/Address: Name/Address: 8. Do You Nee To Construct a Driveway? YES o N ' CIRCLE ONE FIELD NOTES 9. Was This S L miffed With A Building Permit? YES or NO) CIRCLE ONE SHADED AREAS OFFICE USE ONLY J New Address: 13 �(soo 'N Av Postal District: (.) ' ( t C P) —I Real Milepost: e 0) Road #: ,7.)C-PL—,k j \ J Left. Right Fire District Z. `.T i- Th Building Permit# Plate Sent or Odd Even Date Paid (6)(3 /C 3Check# C'p\ Receipt# lef3 .11 I Date in Computed /ALA/L.6 122 - e,M ct( (R, 1 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 $ la,- 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 If you are constructing a driveway that will connect with a county road, you must apply fo j .. a road approach permit. The fee is $ jam- 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 $ I f56.- If you have additional questions, call the Department of Community Development at(360)379-4450. h:lhome 1pincntrlintodpw\instruct.doc 1/1/05 ■ Map`Output Page 1 of 1 ArcIMS HTML Viewer Map F. —rat,saa26 I �; 711,164027 i 74tt65003 tii____,,,,,...,101,.. „._ 701184035 701185.001 _ 7t1ti85o112 701184030 101184036 --, 74/163514.~' 70at834i?463019 "'t `'� ., a 701186002 701163011 r 7011S4�ti "4, apt' yy „� W 701764037 `' 70 11 B:lCj91 1840151 ,f .70118403$ .,,, - Fura con. �.a f�-' :011050:ri Legend 701184414�-} '.. fib - SeteCted Fo tt 101184006` ' 741184040 -, �' -,� Towns 70116 6.F - O t ,,sei /tlhA 1 t. 701184014"-n .°tr - > " ;; �, II_ T4118NKi9 3C FRO$di 701184dQl I� ?a�cals-3•i 701184019 �ry" �(� ,r L�7 8ounda�ie3 70t184020I "' '., ❑ Ill 741184018 70118,5016 j 701185015 �,\ f 701184049:` l I Niax 701184022 .1, . cart-es 'fig'" "` ? +g```r 3 •781,84004 j - �' 70 1 1 64 032" 7t 741141049` 4y`�%**� . 7411'$1404" ---L.,— k�' ��q-.. a u i �r .`• : .� i,•,i 701,91557: 7871ffi54ii7 �t .. /171141405 rse j\ i�. . . . ' n el' '''t 70 1 195 0 1 5 i- t r119tbt1 .krott�J50t6 11:usav�`dcd 4{.t.-thz-.r»CarKy Cttms,a^esn.zs 615 4 M1+.n e. i'O,t?t t .,c„ t 74",t4'.G!i ?: ' 4591),';. FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respec correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Tue Jun 2008 http://gisserver/servlet/com.let/com.es 6/3/2008 , . Address Database Comparison Page 1 of 3 Enter Street Name String: Or Enter Parcel Number: I i I PUBLIC WORKS ADVANTAGE DB ASSESSOR DB MASTER DB ADDRESS PARCEL ADDRESS PARCEL ADDRESS PARCEL ADDRESS PARCEL 0 EAST QUILCENE RD 701184041 0 EAST QUILCENE RD 791304015 11:131 EAST QUILCENE No Addresses Found 1051 EAST QUILCENE 0 EAST QUILCENE RD 701183010 RD 201.184030 RD 701184012 482 EAST QUILCENE 1040 EAST QUILCENE 701183009. 1073 EAST QUILCENE RD 702130910. RD RD 701184035. 1051 EAST 484 EAST QUILCENE QUILCENE 1075 EAST QUILCENE RD 701183002. RD 701_184012 RD 701184908 980 EAST QUILCENE 1073 EAST_QUILQENE 701.18.4035 1077 EAST QUILCENE RD 701163019. RO RD 7Q_11$4Q0y°., 1075 EAST QSli!<C6NE 1031 EAST QUILCENE 701184.0.39 RD 701184908 1090 EAST QUILCENE 7q 7,164015 RD RD 1040 EAST QUILCENE 1077 EAST_QUILCENE 1131 EAST QUILCENE RD 701.7..8.309.9 RD 7Q1.184Q�'3 RD 701104037 1051 EAST QUILCENE 1079EAST QUILCENE 1150 EAST QUILCENE RD 701184012 RD 701164036 RD 701184008 1073 EAST QUILCENE 1090_EAST QUILCENE 701184015 1170 EAST QUILCENE RD 701184035 RD RD 701184021 it l,Q EA$T QUILCENE 1075 EAST QUILCENE 291184038 RD 701184011 1192 EAST QUILCENE 701184019 RD RD -------— 1134 EAST 1079 EAST QUILCENE QUILCENE 701184006 1210 EAST QUILCENE RD 791184036 RD RD 701.184099 1090 EAST QUILCENE 1131._EAST QUILCENE 1225 EAST QUILCENE RD 701184015 RD 701.184037. RD 741185004 lYSOEAST QU_LL_CENE 1110 EAST QUILCENE 701184008. 1270 EAST QUILCENE RD 701184011 RD RD 79_1,184002 1160.EAST QUILCENE 1130 EAST QUILCENE 701184014 1671 EAST QUILCENE RD 791184006 RD RD 701195003 1131 EAST QUILCENE 7111184037 Rp 0EAST QLCENE 701184021 1954 EAST QUILCENE RD RD 7011940.1.0 1150 EAST QUILCENE 1192 EAST QUILC_.E_N6 701184019 2022 EAST QUILCENE RD 701184008 RD RD 701124024 11 1160 EAST QUILCENE 94 EAST_QUILCEN( 2026 EAST QUILCENE RD 701184014 RD 791184019 RD 701.194026 Y2Q0_EAST.QUILQENE 1170 EAST QUILCENE �1184Q21 791184018 2062 EAST QUILCENE RD RD RD 70194025 ,1 1192 EAST QUILCENE 1210_E86_T QLWLCENE 701184009 2090 EAST QUILCENE RD 7011 04019 RD RD 701194007 1200 EAST QUILCENE 1227_EAST QUILCENE 2110 EAST QUILCENE RD 701184018 RQ 701185009 RD 7_01194005 1210 EAST QUILCENE 1260 EAST QUILCENE 701184004 2123 EAST QUILCENE RD 701184009 RD RD 701194094. 70�AST QU[LCE,NE 1260 EAST QUILCENE 701184004 R12D 701194032 2170 EAST QUILCENE RD RD 701194006 1270 EAST QUILCENE 1310_EAST QUILCENE 2242 EAST QUILCENE RD 741184032 RD 201121.909 RD 701194_0.13 1310 EAST QUILCENE 1330 EAST LCENE QUI 2244 EAST QUILCENE RD 701_1.91009 RD —_ 701191005 RD 791194013 1399 EAST QUILCENE 1330 EAST QUILCENE 701191005 701191004 2251 EAST QUILCENE RD RD RD 70203008 1420 EAST ILCENE 1360 EAST QUILCENE 7011910.12. 2253 EAST QUILCENE RD 701191044 RD RD 701194003 1420 EAST QUILCENE 1440 EAST QUILCENE 701191010 2257 EAST QUILCENE RD 701191012 RD RD 701194017 1520 EAST 1440 EAST QUILCENE QUILCENE 701191016 2290 EAST QUILCENE RD 791191010 RD RD 701194018 1520 EAST QUILCENE 1591 EAST QUILCENE 701185016 2300 EAST QUILCENE RD 701191016 RD RD 701194016 1671 EAST QUILCENE 1597_EAST QUILCENE 701195011. 2322 EAST QUILCENE RD 701195003 RD RD 7011940.15 1954 EAST QUILCENE 10.9_9 EAST QU.I_LCENE 701185.01_2. 2350 EAST QUILCENE 701194411 RD 7011940_10 RD http://www.co.jefferson.wa.us/IDMS/DEVTEST/address.asp?street=EAST+QUIZ&parcel= 6/3/2008 , Address Database Comparison Page 2 of 3 RD 2022 EAST QUILCENE 1671_EA9T._QUIL�NE 701194024 -- 70.112500.3.. 2570 EAST QUILCENE - RD RD 701301016 2026 EAST QUILCENE 1944 EAST QUILCENE 2590 EAST QUILCENE RD ? 194026 1.13 -7022.24020 RD 70130100¢ 2062 EAST QUILCENE 1 Q 701194025 95_4--EAST QUILCE-NE 7011940_._10_ 2630 EAST QUILCENE RD RD RD 701301009 2090 EAST QUILCENE 2022 EAST QUILCENE ULLC.ENE 701194007 - 701194.024 2690 EAST QUILCENE RD RD_ RD 701301017 2110 EAST QUILCENE 2020 EAST QUILCENE 2701 EAST QUILCENE RD 7011940.0_.5 RD- 701194026 RD 701292032 2123 EAST QUILCENE 2062_EAST QUILCENE 701194004 -- 701194025 RD - - 2701 EAST QUILCENE RD 70129 RD .2010 2170 EAST QUILCENE 2064 EAST OUILCENE 2701 EAST QUILCENE RD 7.01.,1,.94006 RD 701194025 RD 7412.920-31. 2242 EAST QUILCENE 2090 EAST QUILCENE RD 701194013 RD 701194007. 2730 EAST QUILCENE 70130101.1 RD 2251 EAST QUILCENE 2110.EAST_QU1.L.CENE 7QiZ03Q48 70_11.940_0_9 323 EAST QUILCENE RD RD RD 7021.34032 2253 EAST QUILCENE 21_2_3_EA_ST QUILCENE 70Y19400-3 - -- - 701194004 3370 EAST QUILCENE RD RD RD 701304009 2257 EAST QUILCENE 21.7-Q._EAST QUILCENE RD 701194017 RD - - 701194006 3371 EAST QUILCENE 701304010. RD 2290 EAST QUILCENE 2242..EAST QUILCENE. 201194018 -- 7011.94013 3416 EAST QUILCENE RD RD RD 701304018 2300 EAST QUILCENE 2244 EAST QUILCENE 701194013 3424 EAST QUILCENE RD 701194016 RD 70130401-1. RD 2322 EAST QUILCENE 701194015 Rp 1 EAST QUILCENE 70120300$ 3580 EAST QUILCENE 7013040_13. RD 2350 EAST QUILCENE 701194011 22 3 EASTQUILCENE. 701194003 3720 EAST QUILCENE 1311004 RD 2570 EAST QUILCENE 2257 EAST QUILCENE 7.013010_10. - 701.194017 3790 EAST QUILCENE RD - - RD 7013 RD 11_00,1 2590 EAST QUILCENE 2290_EAST QUILCENE 70_1,301.006 - 7011 94018 3921 EAST QUILCENE RD RD 01 7 RD 2630 EAST QUILCENE 2300 EA_ST QUILCENE RD 701301009 RD - 701194016 4132 EAST QUILCENE 70131.1.0_19 RD 2690 EAST QUILCENE 2322 EAST QUILCENE 701301017 701194015. 4213 EAST QUILCENE RD RD RD 7013.,14009 2701 EAST QUILCENE 2324 EAST tZI1aCE_N.E RD 701292010 RD --�- 701194015 4380 EAST QUILCENE 701311015 - RD 2730 EAST QUILCENE 701301011 2.350 EAST QUILCENE 70.11.93011, 4440 EAST QUILCENE 701314002 RD RD 2912 EAST QUILCENE 2570-EAST QUILCENE RD 701304001 RD _ - 7p130_lO1G 4721 EAST QUILCENE 701.314004 RD 3370 EAST QUILCENE 2590 EAST QUILCENE 4818 EAST QUILCENE RD 7013.0.40_09 RD 7.0.1301006 RD 70_1314905. 3371 EAST QUILCENE 2630 EAST QUILCENE 701304010 - - - - 70 1301009 482 EAST QUILCENE RD "" RD RD 702133010_ 3376 EAST QUILCENE 2490_EAST QUILCENE 701301017 484 EAST QUILCENE RD 70130400$ RD RD 701183.002 3416 EAST QUILCENE 2730 EAST 70_1304018 -- QUILCENE 7 980 EAST QUILCENE RD RD 0.13010.1.1 7011830 RD 19 2912 EA SI 3580 EAST QUILCENE _ _ QUILCEE RD 701304013 RD - N 701304001 3590 EAST QUILCENE 323 EASLQUILCENE 701304014 -- Rp RD -- — 7021340.3.2" 3704 EAST QUILCENE .T QUILCENE RD 7013110.08 RD- 337Q_ ,S-- - 74130_40_09 3720 EAST QUILCENE 3371_EAST QUILCENE RD 7013.1-1.004 - 701364010 RD 3790 EAST QUILCENE 7013 337§EAST QUILCENE RD 110_01. RD 791304008. 3795 EAST QUILCENE C 70131 3416 EAST QUILENE 1023 701304018 RD RD 3914 EAST QUILCENE 701311020 3D 0 EAST QUILCENE 701304013. 3921 EAST QUILCENE 70131.1022 3590 EAST QUILCENE 7 ' RD - RP - 41304014 3962 EAST QUILCENE 70131102_1 3704 EAST_Q191cENE 741311048 http://www.co Jefferson.wa.us/IDMS/DEVTEST/address.asp?street=EAST+QUIZ&parcel= 6/3/2008 . Address Database Comparison Page 3 of 3 RD RD 4125 EAST QUILCENE 701311019 337720_.EAST QUILCENE 701311004 RD 4264 EAST QUILCENE 32.90 EAST QUILCENE 701311018 . 701311001 RD RD 4380 EAST QUILCENE 3795_EASLQUILC_ENE, 701311015 701311023 RD RD-- 4440 EAST QUILCENE 3914_EAS_T QUILCENE RD 701314002 Rp- 701311020 4506 EAST QUILCENE 701314001 3_921 ST QUILCENE 701311022 RD 4890 EAST QUILCENE 3962_EAST QUILCENE RD 95.1709003 RD 701311021 4264EAST QUILCENE RD 7.0.1.3.1.101,8 4330.tASI,QUILCENE 701311015 RD 4440 EAST QUILCENE 701314002 RD 4506 EAST QUILCENE 701314010 RD 4721 EAST QUILCENE RD 701314005. 4818 EAST QUILCENE RD 70131400$ 482 EASTQUILCENE 702.13301.0 RD 484 EAST.QUILCENE RD 7011_.8300.2. 4$90 EASTQUILCENE 701314008 RD 4891 EAST QUILCENE 701314003 RD 980_EAST QUILCENE 701183019 Rp For an address search, leave the parcel field blank.This is the signal that you want an address search. For a parcel search, enter the nine digit parcel number. During a parcel search it does not matter what you have in the address box. This tool uses a "fuzzy" search so if you enter"ZELATCHED"you will get all addresses that have that word in it. If you enter "ZELATCHED POINT RD"you will only get the addresses that have that exact sequence of characters In it. This should allow you to identify the source of many of the discrepancies between the data sources. For instance, searching for"AZALEA LN"gives only 5 addresses in the Advantage DB. Searching for just"AZALEA" adds another address because one was entered incorrectly as "AVE". I purposely did not make a street picklist so you can have flexibility in your searches. The far right column is the final list of addresses that will be loaded into the AS400. Clicking on the address field will give you details about the address. On the details page you can click on links to get a map of the road or search for more addresses on the parcel. Addresses that have a parcel that is not on our parcel map will not show up on this list as a hyperlink, There are many "dummy" addresses in the Advantage DB. Most of these have been filtered out by checking for a blank street address number. The Assessor DB has been filtered by checking for null in the street address number field. Let me._know if this tool is useful and/or how it can be made more useful. http://www.co Jefferson.wa.us/IDMS/DEVTEST/address.asp?street=EAST+QUIL&parcel= 6/3/2008 . Address Database Comparison Page 1 of 3 Enter Street Name String: Or Enter Parcel Number: GO. PUBLIC WORKS DB ADVANTAGE DB ASSESSOR DB MASTER ADDRESS PARCEL ADDRESS PARCEL ADDRESS PARCEL ADDRESS PARCEL 1031 E QUILCENE RD 3376 E QUILCENE RD 701304008 No Addresses Found No Addresses Found 1040 E QUILCENE RD 1051 E QUILCENE RD 1073 E QUILCENE RD 1075 E QUILCENE RD 1077 E QUILCENE RD 1079 E QUILCENE RD 1090 E QUILCENE RD 1110 E QUILCENE RD 1130 E QUILCENE RD 1131 E QUILCENE RD 1150 E QUILCENE RD 1160 E QUILCENE RD 1170 E QUILCENE RD 1192#1 E QUILCENE RD 1192#2 E QUILCENE RD 1194 E QUILCENE RD 1200 E QUILCENE RD 1210 E QUILCENE RD 1223 E QUILCENE RD 70.1.185011 1225 E QUILCENE RD 1227 E QUILCENE RD 701185009 1229 E QUILCENE RD 701185002 1260 E QUILCENE RD 1270 E QUILCENE RD 701184432 1310E QUILCENE RD 1320 E QUILCENE RD 70119100.7 1330 E QUILCENE RD 1360 E QUILCENE RD 1420 E QUILCENE RD 1440 E QUILCENE RD 1500 E QUILCENE RD 1520 E QUILCENE RD 1591 E QUILCENE RD 1593 E QUILCENE RD 70119501.6 1593 E QUILCENE RD 701195016 1593 E QUILCENE RD 701195010 1595 E QUILCENE RD 701185013 1597 E QUILCENE RD 701195011 1599 E QUILCENE RD 701185012 1671 E QUILCENE RD 1920 E QUILCENE RD 1944 E QUILCENE RD 702224020 1954 E QUILCENE RD 1981 E QUILCENE RD 2022 E QUILCENE RD 2026 E QUILCENE RD 701194026 2062 E QUILCENE RD • 2064 E QUILCENE RD 2090 E QUILCENE RD 2110 E QUILCENE RD 2123 E QUILCENE RD 701.194004. http://www.co.Jefferson.wa.us/IDMS/DEVTEST/address.asp?street=E+QUILCENE&parcel= 6/3/2008 , Address Database Comparison Page 2 of 3 2170 E QUILCENE RD 2242 E QUILCENE RD 2244 E QUILCENE RD 2251 E QUILCENE RD 2253 E QUILCENE RD 701194003 2257 E QUILCENE RD 701194017 2290 E QUILCENE RD 2300 E QUILCENE RD 2322 E QUILCENE RD 2324 E QUILCENE RD 2350 E QUILCENE RD 2570 E QUILCENE RD 2590 E QUILCENE RD 2630 E QUILCENE RD 2690 E QUILCENE RD 2701 E QUILCENE RD 701292010 2912 E QUILCENE RD 2972 E QUILCENE RD 2976 E QUILCENE RD 323 E QUILCENE RD 70213402 3370 E QUILCENE RD 3371 E QUILCENE RD 3376 E QUILCENE RD 3380 E QUILCENE RD 3416 E QUILCENE RD 701.304418 3424 E QUILCENE RD 701344034 350 E QUILCENE RD 3580 E QUILCENE RD 3590 E QUILCENE RD 3704 E QUILCENE RD 701 311_08 3720 E QUILCENE RD 3790 E QUILCENE RD 3795 E QUILCENE RD 3914 E QUILCENE RD 3921E QUILCENE RD 3962 E QUILCENE RD 4125E QUILCENE RD 701311019 4132 E QUILCENE RD 70_13.11019 4213 E QUILCENE RD 70.1314009 4264 E QUILCENE RD 70_1311018, 4380 E QUILCENE RD 4440 E QUILCENE RD 4452 E QUILCENE RD 4454 E QUILCENE RD 4506 E QUILCENE RD 701314091 4721 E QUILCENE RD 4818 E QUILCENE RD 482 E QUILCENE RD 484 E QUILCENE RD 4890 E QUILCENE RD 70131.4008 4891 E QUILCENE RD 980 E QUILCENE RD 981 E QUILCENE RD 982 E QUILCENE RD 984 E QUILCENE RD For an address search, leave the parcel field blank.This is the signal that you want an address search. For a parcel search, enter the nine digit parcel number. During a parcel search it does not matter what you have in the address box. http://www.co.jefferson.wa.us/IDMS/DEVTEST/address.asp?street=E+QUILCENE&parcel= 6/3/2008 • , Address Database Comparison Page 3 of 3 This tool uses a "fuzzy" search so if you enter"ZELATCHED"you will get all addresses that have that word in it. If you enter "ZELATCHED POINT RD" you will only get the addresses that have that exact sequence of characters in it. This should allow you to identify the source of many of the discrepancies between the data sources. For instance, searching for"AZALEA LN" gives only 5 addresses in the Advantage DB. Searching for just"AZALEA" adds another address because one was entered incorrectly as "AVE". I purposely did not make a street picklist so you can have flexibility in your searches. The far right column is the final list of addresses that will be loaded into the AS400. Clicking on the address field will give you details about the address. On the details page you can click on links to get a map of the road or search for more addresses on the parcel. Addresses that have a parcel that is not on our parcel map will not show up on this list as a hyperlink. There are many"dummy" addresses In the Advantage DB. Most of these have been filtered out by checking for a blank street address number. The Assessor DB has been filtered by checking for null in the street address number field. Let m. e_know If this tool is useful and/or how it can be made more useful. http://www.co.jefferson.wa.us/IDMS/DEVTEST/address.asp?street=E+QUILCENE&parcel= 6/3/2008 APPLICATION FOR ROAD P ROACH PERM ' Jefferson County Permit# Depart:ne:.:A:Community Development ,i Receipt# CC) I 621 Sheridan Street Check# Port Townsend, WA 98368 (5t ` ,, Date Paid (n--.3-OR(360) 379-4450 APPLICANT PLEASE PRINT OR TYPE ALL INFORMATION -CHECK BOXES THAT APPLY Residential Approach ❑ Logging Approach ❑ Temporary ECommerical Approach Improvements Only 0 Approach&Address County Road Name: -09,11_ Mile Post#: (office use only) Al& A-l z�� k� I hereby designate Applicant or Authorized Representative (Contractor) to act as my agent In matters related to this Contractor Lic.# appli..tion for •- mit(s). • ,Z,G4) d(C�u2 L It / / <_-oseP Mailing Address • ner Signature Date 6...4 /City Zip Code Parcel Number Telephone No. Flagging Color&Date A CK NOWLE DG EM ENrS By signingthe application form,the applicant attests that the information provided herein istrue and correct to the best of their knowledge and agrees to all 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 save,indemnify and hold harmless Jefferson County against all liabilties,judgment,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 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 Ad"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 Applica acknowledesAM he,she or it hokis individual and non-transferable responsibiity for adhering to and complying with the ESA. The Appica has read this i laim and signs and dates it below. - 61IZ)g - (APPLIC TOR AUTHOR! ED REPRESENTATIVE SIGNATURE) (DAT ) Updated 2/12/2008 • ENVIRONMENTALLY SENSITIVE AREAS REVIEW •RAP08-00056 Owner: SCOTT ABBOTT Site Address: ANNE RICKER EAST QUILCENE RD 1160 E QUILCENE RD WA, QUILCENE WA 983769505 Parcel Number: 701184040 S-T-R: 18-27N-01W Legal Description S18 T27 Rl W TAX 69 W/EASE Total Acreage: 4 Fire District: 2 Planning Area: 10 Flood Map (FIRM)Panel No: Flood District: School District 48 WATER SUPPLY UTILITY: Service Area PUD: [ ] Assesor's Map [ ] Forest Lands: Adjoining Forest Lands: [ ] ESA'S Wetlands: Aquifer Recharge Area: Flood: Erosion: Landslide: Seismic: Fish&Wildlife: Stream Type: Shoreline Designation: SIPZ: Flood Certificate: Violations: Require Declaration of Restrictive Covenant to meet minimum land area Recorded Date of Subdivision: <5yrs=Plat Conditions on plat or Old Ordinance PARCEL TAGS: No parcel tags found for this parcel. Associated CASES status issued finaled description RAP08-00056 P RAP&911 SEP07-00040 P This Drainfield serves parcel 701 184 039 SEP07-00041 P USR08-00023 P I:\F_MLT_ESA_Review.rpt June 03,2008