HomeMy WebLinkAboutLand Division Supplemental ApplicationSpN C
DEPARTMENT OF COMMUNITY DEV
6'_ I Sh,r,d n 911,11, h I I fowns,vJ, AG A 98368
11360.3 9 lin f- -.3601 3-44 1
; ,1111, ,r, agae ,l„4 n r OCT — 4 2016
9sgINpT
SUPPLEMENTAL APPLICATION01ERsoyCaumly
LAND DIVISION �l€nto=_cO�na11N!1YOEvHn'.
MIA PROJECTIAPPLICANT NAME: Sn.eAlns¢�n
If I n t�('1R�ISui3tl� — ii t,g
Submittal Requirements
1. A Completed Permit Application and State Environmental Policy Act (SEPA) Checklist (if applicable).
Representative authorization is required if application is not signed by owner.
2. Short Plat, Long Plat or Binding Site Plan application fee (as applicable), as set forth in the Jefferson County
Fee Ordinance, as amended.
3. Any supplemental information identified by the Administrator.
4. Certificate of Water Supply Utility Service Form.
5. Five (5) paper Copies of a preliminary plat meeting the requirements of Jefferson County Code (JCC)
18.35.110 and 16.35.120 for short plats, or JCC 18.35.290 and 18. 35.300 for long subdivisions/binding site
plans and identifying points of access, all easements, deeds, restrictions, or other encumbrances restricting
the use of the property, as applicable. Copies of the applicable JCC sections are attached for your use.
6. Where site conditions require a special report to assess or address any probable significant adverse
environmental impacts, a study (or studies, as applicable) prepared by a competent professional may be
required if deemed necessary by the Administrator.
7. Evidence of Compliance with JCC 18.30.070, Stormwater Management Standards, as deemed necessary by
the Administrator.
8. The preliminary plat must be prepared in accordance with JCC 18.35, 110 for short plats, or 18. 35.290 for
long plats. The contents of the preliminary plat must provide the information listed in 18.35.120 for short
plats and 18.35 300 for long plats.
9. The following supplemental information:
Subdivision Name: 'S&c \asen SVS T
Land Use (check one):
Industrial
®"Residential
❑ Commercial ❑
Total Acreage of Property:
Total Lots Proposed. 2
Water Supply (check one):
RYCommunity Water System
Sewage Disposal Method.
05S
Average Lot Size: C0
r*ch. Minimum Lot Size: 5.9 Open Spam. d
Page 1
10, , do hereby swear and certify that in addition to the land
subject to this application (check the box below which applies)'
I have no Interest In
❑ 1 nave an interest In
land within 300 feet of any portion of the subiect properly by reason of ownership, contract, for purchase by
agreement or option by any person, famiry member, nam, or corporation In any manner connected with me or
fie development
3e-4- W— Itd /T
31Gwa„nE nATE
11. The applicant hereby certifies that the preliminary plat provides an accurate representation of the proposed
land division; and the applicant hereby acknowledges that any approval issued on this application may be
revoked if any such statement is round to be false-
SIGNATURE DATE
a 2015
D
lU4CNSGY C111:JiV
nru m cros��nrnv ntveinP"—[nT—