HomeMy WebLinkAboutMLA16-00036 Supplemental ApplicationDEPARTMENT OF COMMUNITY DEVELOP2
621 Sheridan Street, Pon Townsend, WA 98368
Tel: 360.379.4450 1 Fax: 360.379.44SI
Web: ...c..iefferson.wa.us/communitvdevelopment A
E-mailk dcoli2cojefferson we us
SUPP MENTAL APPLICATION olvCOU/0),"
PLAT VACATION/ALTERATION Dco
Mi -A# PROJECTIAPPLICANT NAME: David Whitney
T,n�,,, Vipw Lona Plat Alteratior
Submittal Requirements
I . A completed Master Permit Appircation. Representative authorization is required if application is not signed by owner.
2. Plat AlterationNacation fee, as set forth in the Jefferson County Fee Ordinance, as amended.
3. Current title company certificatontplat certificate.
4� a. For a plat vacation, signatures of all parties having an ownership interest in that portion of the shod plat, long plat, or
binding site plan subject to the proposed vacation; or
b. For a plat alteration or replat, signatures of a me onty of those parties berving an ownership interest of the lots, tracts,
parcels, sites or divisions in the subject short plat, long plat or binding site plan, or portion to be altered.
5. A copy of any covenants conditions and restrictions (CC&Rs), deed restrictions, easements, Planned rural residenfial
development iPRRD) agreements, or other encurnbrances restricting the use of the property.
6. Five (5) paper copies of the plat map and any surveys of record, with proposed alteration(s) or varation(s) depicted in red ink.
7. Any additional information reasonably deemed necessary by the Administrator to evaluate the proposed alteration or vacation.
8. Descrite the proposed afteration(s) or vacationist and the purpose(s) for the request. (Attach additional sheets, If necessary):
Road easement is moving to the east to give Lots 7 & 8 a buildable area bemuse of the slope to the west. Open
space size will not change bemuse of area exchange in Lot 7.
9. is the short plat, long plat or binding site plan adjacent to the right-of-way of a state highway or within two (2) miles of the
boundary of a state or municipal airport. If yes, Department of Community Development staff shall send Notice of Application to
the Secretary of Transportation for review and comment.
0 Yes IF No
10. IS the short Plat, long plat or binding site plan located within one (1) mile of a city or county boundary, If yes, Department of
Community Development Staff shall send Notice of Application to the affected city or county for reView and comment.
OYes (F) No
11. Would the application for alteration or vacation result in the violation of a covenant? If yes, the application shall contain an
agreement signed by all parties subject to the coverant(s) providing that the parties agree to terminate or alter the relevant
covenant(s) to accomplish the purpose of the afteration or vacation of the plat or binding site plan, or portion thereof.
Yes r -'A No
.7�
12. Would the application for alteration or vacation result in the violation of any deed restrictions, easements, planned rural
residential development (PRRD) agreements, covenants conditions and restrictions (CC&Rs) or other encumbrances restricting
the use of the property?
() Yes q) No
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13. Is any land within the proposed alteration or vacation within the limits of an assessment district?
) Yes It ) No
14. Does any of the land within the proposed alteration or vacation Contain a dedication to the general use of persons residing within
the short plat, long plat, or binding site plan? -
eYes C)No
15. The applicant(s) hereby certifies that all the above statements are true and that the plot plan provides an accurate
representation of the proposed alteration or vacation, and the applimnt(s) hereby acknowledges that any permit issued on this
appli ere ak lif ny3D h statement is found to be false. 996400001
David Whitney996400008 March 24, 2016
APPLICANT'SSIGNATU NOP NUMBER) 996400003 996400010 DATE
* 996400004 996400005 March 24, 2016
John Whitney 996400011
PROPERTY OWNERS SIG I RE (yAO ARCEL NUMBER) 996400006 DATE
Mary 996400009 March 24, 2016
Whitney-Hall 996400002
PROPERTY OWNERS SIGNATURE (AND RCE, NUMBER) DATE
John Nelson 601342019 March 24, 2016
PROPERTY OWNERS SIGNATURE (AND PARCEL NUMBER) DATE
PROPERTY OWNERS SIGWVURE (AND PARCEL NUMBER) DATE
(NOTE: For all required signatures, representative authorization is required If application is not signed by the owner.)
*Kent L. Robinson, P.L.S.
Northwestern Territories, Inc. (Agent)
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