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Home My WebLink AboutPermit ApplicationSteps in the Permit Process: DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 Tel: 360.379.4450 1 Fax: 360.379.4451 Web: F -mail: �lccl{r�tco,jctter>crn.�ua.us PERMIT APPLICATION -Review application checklist to ensure all information is completed prior to submitting -Make sure septic has been applied for and water availability has been proven. zss -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application; it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Building Permit # Related Application #s: MLA # Site Information Assessor Tax Parcel Number: Site Address and/or Directions to Property: DNR Aquatic land leases 20-A11121 & 20-A1128, Dabob Bay Section 15-22 Township 27N Range 1W 47.8386N, -122.809W to 47.8222N, -122.7946W NAD83 Access (name of street(s)) from which access will be gained: No land access proposed; boat access only, Present use of property: Shellfish aquaculture Description of Work (include proposed uses): Continuation of existing aquaculture operations and addition of oyster tumble bags. Wastewater - Sewage Disposal This property is served by Port Townsend or Port Ludlow sewer system? YES NO X If not served by sewer identified above, identify type of septic system below: Type of Sewage System Serving Property: Septic Septic Permit #: Community Septic Name of System: Case #: Are other residences connected to the septic system? Additions or repairs to sewage system: Is it a complete or partial system installation: Complete Partial Has a reserve drainfield been designated? Yes No Date of Last Operations & Maintenance check: Attach last report to application Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: Not applicable. No structures requiring septic sstern are proposed. LP-C� 1"mul ' 11+ l 1", Y!L I of Z The authorized agent/representative is the primary contact for all project -related questions and correspondence. The County will mail / e-mail requests and information about the application to the authorized agent/representative and will copy (cc) the owner noted below. The authorized agent/representative is responsible for communicating the information to all parties involved with the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email (i.e., Countv email is not blocked or sent to "junk mail")- Applicant/Property ail"). Applicant/Property Owner Information Property Owner: Name: Washington State Department of Natural Resources Address: 5310 Ea lemount Rd Chimacum WA 98325 Phone #: (360) 732-7411 E-mail Address: sean.carlson@dnr.wa.gov X Please contact Authorized Agent/Representative with project info. (select only one). Property Owner Signature: Date: Note: For projects with multiple owners, attach a separate sheet with each owner(s) information and signatures. Applicant: Authorized Agent/Representative (If other than owner) Name: Ron Allen and Jeromy Sullivan, Tribal Chairmen of the Jamestown and Port Gamble S'Klallam Tribes Address: 1033 Old Blyn Hwy Sequim, WA 98382 Phone #: (360)681-4630 an (360)460-3240 E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES X Engineer Architect Surveyor Contractor Consultant X Name: Ralph Riccio License # Address: 1033 Old Bl n Hwy Se uirn WA 98382 Phone #: (360)681-4630 E-mail Address: rriccio@'amestowntribe.or Professional: Is this an Authorized Agent/Representative for this project? NO YES X Engineer Architect Surveyor Contractor Consultant X Name: Shannon Miller License # Address: 19472 Powder Hill Place NE Suite 210 Poulsbo, WA 98370 Phone #: (360) 297-6526 E-mail Address: smiller@pnptc.org Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: License # Address: Phone #: E-mail Address: By signing this application form, the owner/agent attests that the information provided herein, and in any attachments, is true and correct to the best of his or her knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in making any issued permit null and void. I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal, state and county laws and regulations and I 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 inspections. Applicant may request notice of q' a CAynN'§jtgtent to enter upon the property for visits related to this application and subsequent permit issuance. Signature:i� X1- Print Name: " Lav) 600 r' . 9, lie(_ Date: DEPARTMENT OF COMMUNITY DEVI 1110PIME 621 Sheridan Street, Port Townserid, WIN 98368 Tel: 360.379.4450 Uaa: 360.3 i 9.4451 Web. dk cloomcnt ""'O( 1; mail: dcd a ) icf er oil- +'a.us '� � ` �> SUPPLEMENTAL APPLICA'T'ION 00 SHORELINE DEVELOPMENT A completed application form is a requirement of submittal. Include "N/A" in spaces that do n;Xa'6bly. MLA # Case # Application Type (select one): Statement of Exemption- Variance* Substantial Development* See Examples on back side of application Conditional Use (administrative)* Conditional Use (discretionary)* 1) Does your proposal require in water work and/or works below ordinary high water mark? Yes[ _� No [ 2) Does your pronn-al require t x,000 sq/ft or more of impervious surface and/or non -single family structures of 5,000 sq/ft or more? Yes [ ] No [ / ] * If either of the boxes for 1 or 2 above are checked yes or if the permit type above has an asterisk then a LeL -apRlication conference is required prior to submitting for a shoreline permit. Site Information Assessor Tax Parcel #: Previous aquaculture activities consisted primarily of on -bottom oyster culture and Manila clam eultwe using predator exelidsion netting. The leases have not been setively faffned sinee 2045—. However, several thousand mature oysters and manila clams that are ready for harvest still Name of Body of Water: Dabob Bay Property owner Name(s): __[ Washington Department of Natural Resources Project Description Describe the existing property use and condition: The project area has been leased for commercial shellfish aquaculture since at least the 1950's. Previous aquaculture activities consisted primarily of on -bottom oyster culture and Manila clam eultwe using predator exelidsion netting. The leases have not been setively faffned sinee 2045—. However, several thousand mature oysters and manila clams that are ready for harvest still remain on the property. Proposed distance from ordinaryhi h water mark to use/development:50 feet Describe the proposed work that requires a shoreline permit or permit exemption: Continue existing on -bottom oyster and Manila clam aquaculture operations. Only new work proposed requiring a Jefferson County permit is the addition o oyster tumble bag culture on no more than 10 acres Tumble baq nvst--r--; are gromin in mesb racu-s or bags which are generally staked-abol it one tn two feet off the bottom. This suspension method is usually done horizontally and staked about one to two feet above a bottom in the Inteffid5l region. rumbled oysters are r5ised in bags with oa s on - them and are periodically bumbled with normal tide mh age - By signing this application form, the owner/agent attests that the information provided herein, and in any attachments, is true and correct to the best of his or her knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in maki an sued Tmit null and void. Owner Signature: �LDate: Print Name: SW040-1 F. A jl6r These activities require a formal statement of Exemption issued by Jefferson County. Check 'Statement of Exemption' box on the front of this form and submit with Permit Application to apply for your Exemption Approval. 18.25.570 Statement of Exemptions (1) The administrator is hereby authorized to grant or deny requests for statements of exemption from the shoreline substantial development permit requirement for uses and developments within shorelines that are specifically listed above. Such statements shall be applied for on forms provided by the administrator. The statement shall be in writing and shall indicate the specific exemption of this program that is being applied to the development, and shall provide a summary of the administrator's analysis of the consistency of the project with this program and the Act. As appropriate, such statements of exemptions shall contain conditions and/or mitigating measures of approval to achieve consistency and compliance with the provisions of this program and Act. A denial of an exemption shall be in writing and shall identify the reason(s) for the denial. The administrator's actions on the issuance of a statement of exemption or a denial are subject to appeal pursuant to the appeal provisions in Article X of this chapter. 18.25.560 Exemptions listed —This is a summary from JCC18.25.560, please review the code section for detailed information regarding these exemptions. (1) Fair Market Value. (2) Maintenance and Repair. (3) Residential Bulkhead. (4) Emergency Construction. (5) Agriculture. (6) Drainage. (7) Navigation Aids. (8) Single -Family Residences. (9) Residential Docks. (10) Irrigation. (11) State Property. (12) Energy Facilities. (13) Site Exploration. (14) Noxious Weeds. (15) Watershed Restoration. (16) "Watershed restoration project" (17) "Watershed restoration plan" (18) A public or private project, the primary purpose of which is to improve fish or wildlife habitat or fish passage. 3 , tC Ir rl US Alm, dips of Enpfnaen WASHINGTON STATE k!nC Joint Aquatic Resources Permit Application (DARPA) hf A Attachment E: Aquatic Use Authorization on Department of Natural Resources (DNR) -managed aquatic lands tr,t itj i-__4----_-AGENCYt1SEONLYi �'�� 1- 1 i)ate received: QL� —L —HQ ; El Town D Application Fee Received; Fee N/A XNew Application; ❑ Renewal Application Type/Prefix #: 2O ; NaturE Use Code: Z�S� LM Initials & BP#:_015 t o 16 RE Assets Finance BP#: 10 1 -1 g New Application Number: ..0 - I I Trust(s): ; County: AQR Plate #(s): ; Gov Lot #(s): I I I I 1 Tax Parcel #(s): - - ---------------------------------------- Complete this attachment and submit it with the completed JARPA form only if you are applying for an Aquatic Use Authorization with DNR. Call (360) 902-1100 or visit http://www.dnr.wa..qov/programs-and- services/aquatics/leasing-and-land-transactions for more information. • DNR recommends you discuss your proposal with a DNR land manager before applying for regulatory permits. Contact your regional land manager for more information on potential permit and survey requirements. You can find your regional land manager by calling (360) 902-1100 or going to http://wa- dnr.s3.amazonaws.coin/ ublications/a r land manager map 072415, df. reel • The applicant may not begin work on DNR -managed aquatic lands until DNR grants an Aquatic Use Authorization. • Include a $25 non-refundable application processing fee, payable to the "Washington Department of Natural Resources." (Contact your Land Manager to determine if and when you are required to pay this fee.) DNR may reject the application at any time prior to issuing the applicant an Aquatic Use Authorization. h[ eft 1. Applicant Name (Last, First, Middle) Allen, Ron 2. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) [help] Point No Point Shellfish Farms in Dabob Bay 3. Phone Number and Email ( 360 )681-4630 rriccio@jamestowntribe.org 4. Which of the following applies to Applicant? Check one and, if applicable, attach the written authority — bylaws, power of attorney, etc. h[ elpj ❑ Corporation ❑ Limited Partnership ❑ General Partnership ❑ Limited Liability Company Home State of Registration: ❑ Individual ❑ Marital Community (Identify spouse): ❑ Government Agency Other (Please Explain): Tribe JARPA Attachment E Revision 2015.2 Page 1 of 2 6. Washington UBI (Unified Business Identifier) number, if applicable: bqlp 6. Are you aware of any existing or previously expired Aquatic Use Authorizations at the project location? ❑ Yes ® No ❑ Don't know If Yes, Authorization number(s): 7. Do you intend to sublease the property to someone else? ❑ Yes ® No If Yes, contact your Land Manager to discuss subleasing. $. If fill material was used previously on DNR -managed aquatic lands, describe below the type of fill material and the purpose for using it. h[ ow N/A To be completed by DNR and a copy returned to the applicant. Signature for projects on DNR -managed aquatic lands: Applicant must obtain the signature of DNR Aquatics District Manager OR Assistant Division Manager if the project is located on DNR -managed aquatic lands. I, a designated representative of the Dept. of Natural Resources, am aware that the project is being proposed on Dept. of Natural Resources -managed aquatic lands and agree that the applicant or his/her representative may pursue the necessary regulatory permits. My signature does not authorize the use of DNR -managed aquatic lands for this project. �o 7a. P-6`�rs nted Name Dept. of Natural Resources District Manager or Assistant Division Manager 9p4D. Signatbfe Dept, of Natural Resources District Manager or Assistant Division Manager Date If you require this document in another format, contact the Governor's Office for Regulatory Innovation and Assistance CORIA) at (800) 917-0043. People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call (877) 833-6341. ORIA Publication RNV -049-12 rev. 09/2015 JARPA Attachment E Revision 2015.2 Page 2 of 2