HomeMy WebLinkAbout69019 JEFFERSON COUNTY
SU1 DINTISION EXEMPTION APPLSCATSAN
S � %Z
The Jefferfson County Subdivision Ordinance exempts certain proposals from
the platting requirements of the Washington State Plats-Subdivisions-
Dedications Act (RCW 58.17). To qualify for an exemption, the proposal must
be reviewed and approved by the Jefferson County Planning and Building
Department.
Please answer the following questions completely, using ink or a typewriter.
,/J o
APPLICANT: o-t o y fr., / �/ d i r u 5 7�r -e h/ 4 / " `'S T
ADDRESS: /0 • l'-- 0 5-
TELEPHONE: (home) /U a el (business)
REPRESENTATIVE/CONTACT:
c , v/ wo a I
ADDRESS: / S S / S c e �Y
TELEPHONE: (home) 3 5 5 ? 6- ' (business) 54 _
PROPERTY AND
PROPOSAL DESCRIPTION
•
GENERAL LOCATION: L !^i 1 /-e 5 tv c 7 (.0
c 4 r r G cC c
4,1Lthe "
•
LEGAL(S) (identify each affected property):
• Owner: 17` f /Q s, �S l`c AY r7 U/a Mc?s�
Address: D - � d (� a s f-
Tax Parcel Number (9 digits): 0 0 / / 8 c-f
Real Property Description: S I g 7- 3 d / ( /
S' 2 Cw
• Owner:
Address:
Tax Parcel Number (9 digits):
Real Property Description:
•
Applicat
ion Roceived 6qn
No determination of a sas ataniihllp
complst.3 application has boon made,
(ps50'
Ii j,rt1,�W«9"a !p 1 o 9
C ,(
PROPOSED ACTION: � ( v -e d
c /T C Y P S
�o A- Ir v1 a !Gt C C. 1-�a o f f-A P�
a 5 / 1 crcys L 0 r(�
La'aO r 1- g �C�
SITE PLAN
A site plan must accompany the exemption request. It shall be no larger
than 11 by 17 inches, to scale, and suitable for copying. It shall illustrate
and identify the following features:
1. North arrow and scale.
2. Existing and proposed property boundaries; identify lengths.
3. Property improvements (well, septic systems, house, etc.).
4. Parcel ownership.
5. Roads serving the property.
OC II c1 (_)01
ACKNOWLEDGEMENT
I hereby declare that the information provided in this application and all
attached material is true and correct to the best of my knowledge.
L T. 5- /5/ q 2-
(authorized signature) (date)
OFFICE USE ONLY
EXEMPTION TYPE: C't
APPLICABLE ORDINANCE SUBSECTION: /O (3)
APPROVED 0 DISAPPROVED
ENTS: Re. 'j A - .11 t I •a 1 1 •, r .,AI 1 ,I IS . 0. .4 0 g � `O,
-.I A t AIWArrgagEURFAMMIMMILIL
MINSIMMINOMPWAMT04
RESPONSIBLE OFFICIAL: �I .,�ff
.rl.►. .1 ,�'
TITLE: � ARM At, .1 rl ` _1.' . .1� .
DATE: 7 c9Mca
COPIES: ;'4f Applicant 0 Public Works Department
n ;1 Representative 0 Health Department
_.�f1Gl usi_ • r� sor's / Q they:• at Ci GtiGG
\.,Q_ • • • 4 fitiaaaW'S 0:WW2, wai -steed':
fact&