HomeMy WebLinkAbout060517_ca07SON JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
p 621 Sheridan Street, Port Townsend, WA 98368 1 Web: www.co.iefferson.wa.us/communitydevelopment
`wsH1 0' Tel: 360.379.44501 Fax: 360.379.4451 1 Email: dcd cDco.iefferson.wa.us
SquareONE Resource Center I Building Permits & Inspections I Development Review I Long Range Planning
Jefferson County
Board of County Commissioners
Consent Agenda Request
To: Board of County Commissioners
Philip Morley
Through: David Greetham, Planning Manager 6-A .
From: Anna Bausher, Associate Planner OA
73Lp
Date: Consent Agenda for June 5th, 2017
Subject: Final Plat Alteration for Lagoon View Long Plat, MLA16-00036 / SUB16-00013
Statement of Issue: Final long plat alteration to realign the easement for Whitney Road (private road)
to create more suitable building sites on lot 7 and 8. The current physical road location will remain in
the proposed right-of-way, therefore no new road construction will be necessary. This alteration also
adjusts the lines to lots 7, 8 and Tract A open space uplands to further create more suitable building
lots. The proposal is located at Whitney Road (Private), Quilcene, WA. Requesting final approval by the
Board per JCC Section 18.35.200 and RCW 58.17.215. Applicant is David Whitney.
Analysis: Staff determined that the application as submitted on April 12th, 2016 met said criteria of
Jefferson County Code Section 18.35.680 and JCC 18.35.690. Approval was granted on January 23rd
2017 with an approved revision on May 8th, 2017. All conditions of approval have been met and verified
by each applicable county department as verified by signing the survey Mylar and copies.
Alternatives: The requested action is mandatory per RCW 58.17.215 and Jefferson County code
Section 18.35.690.
Fiscal Impact: There is no identifiable fiscal impact related to this request for final plat alteration
approval. Applicants have paid 2017 full year property taxes for involved parcels.
Recommendation: Per Jefferson County Ordinance and State Law, DCD requests that the Board grant
final long plat alteration approval.
Reviewed by:
-7
- Phifiip Morley, Coujfty Administrator
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PAGES 84-86, RECORDS OF JEFFERSON COUNT); WASHINGTON, FOR
OUNDARY LINES OF THESE AFFECTED LOTS, FOR ADDITIONAL SECTION
)BDMSION INFORMATION, SEE LONG PLAT, VOL.7 PG.84-86.
AL DESCRIPTIONS OF PRE AND POST LOTS, SEE SHEET 2 OF J OF
PLAT ALTERATION.
-D MONUMENTS WERE FOUND TO BE WITHIN 0.50 FOOT OF THEIR
POSITIONS. ALL MONUMENTS PREVIOUSLY SET AND FOUND BY THIS
7E HELD AS LOT CORNERS. AT THE FOUND POSITIONS AS
7 HEREON.
FOR THIS SURVEY WAS PERFORMED IN SEPTEMBER, 2015. 7377"
ERE SET OC70SER 26TK 2016.
AS HEREON ARE CALCULATED TO THE CLOSING LINES" AS SHOWN.
OF EACH LOT (ORDINARY HIGH WATER) HAS NOT BEEF DETERMINED
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SURVMR'S CERTIFICATE
'RRECTLY REPRESENTS A SURVEY MADE BY ME OR UNDER MY DIREC77ON IN
E WITH THE REQUIREMENTS OF THE SURVEY RECORDIN ACT AT THE
DAVID WHITNEY, COMPLETED IN SEPTEMBER ,AAD OC ER OF 29A6.
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FILED FOR RECORD THIS
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AT THE REQUEST OF NC
ISDN JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
UNIFIED DEVELOPMENT CODE
TYPE II LAND USE PERMIT
G1 0
APPLICANT: SEAMAN VENTURES LLC
C/O DAVID W WHITNEY
9817 MONA LISA LN
BAKERSVILLE CA 93312
DATE ISSUED: January 25, 2017 P Rev\Se.c��e,�M'N awroyrk (Ae. MC g 2Q��
DATE EXPIRES: January 25, 2018 i
MLA NUMBER: MLA16-00036
PROJECT PLANNER: Anna Bausher
PROJECT DESCRIPTION:
SUB16-00013 - *Revision' Tax 35 (Parcel 601 342 019) is no longer involved in this plat alteration. Revised proposal
is as follows:
Plat Alteration of Lagoon View Long Plat (SUB97-00004).The proposal is to realign the easement for Whitney Road
(private road) to create more suitable building sites on lot 7 and 8. In addition to adjusting lots 7, 8, and Open Space
Tract A in the plat (parcel numbers 996 400 007, 996 400 008, and 996 400 012). The current physical road location
will remain in the proposed right-of-way, therefore no new road construction will be necessary. The proposal to adjust
these parcel lines and right-of-way is to obtain more buildable parcels. The proposal is exempt from SEPA review
under WAC 197-11-800(6)(f).
Original Approved Proposal: Plat Alteration of Lagoon View Long Plat (SUB97-00004).The proposal is to realign the
easement for Whitney Road (private road) to create more suitable building sites on lot 7 and 8. In addition to
adjusting lots 7, 8, and Open Space Tract A in the plat as well as one parcel, Tax 35, located outside of the plat
(parcel numbers 996 400 007, 996 400 008, 996 400 012, and 601 342 019). The current physical road location will
remain in the proposed right-of-way, therefore no new road construction will be necessary. The proposal to adjust
these parcel lines and right-of-way is to obtain more buildable parcels. The proposal is exempt from SEPA review
under WAC 197-11-800(6)(f).
PROJECT LOCATION:
Parcel numbers: 996 400 001, 996 400 002, 996 400 003, 996 400 004, 996 400 005, 996 400 006, 996 400 007, 996
400 008, 996 400 009, 996 400 010, 996 400 011, 996 400 012; S34-T26N-R1 W and S27 -26N -1W; Site address:
Whitney Road, Quilcene, WA 98376.
CONDITIONS:
1.) Jefferson County Environmental Health Department requires, the location of soil test pits to be graphically
portrayed on the final survey
2.) Approval of this Plat Alteration by Jefferson County Public Health is no assurance that the existing or proposed
on-site septic systems are adequate or suitable for the: existing uses or buildings, the shown proposed
improvements or any other future expansions or modifications. Compliance with the current On -Site sewage
code at the time of application is required.
3.) Any new or replacement residence may be connected to a pre-existing on-site sewage system only when the
pre-existing system has hydraulic capacity, sufficient vertical and horizontal separation, an adequate reserve are
and satisfies all other requirements to be in compliance with current code.
4.) Prior to final sign off of the Plat Alteration the following is required:
1) Identify what the "Building" is on lot 8
2) Along the south property line of Lot 8. Change the wording from "Approximate location of former drainfield
no longer in use" to "Approximate location of former septic system now decommissioned". Also this includes
the adjacent septic tank so please add an arrow to it as well.
5.) The Auditors File Numbers for the Road Maintenance Agreement and Covenants and Restrictions shall be filled
in on the mylar.
6.) All stamps/seals and signatures on the mylar shall be in black ink. Please ensure all stamps/seals do not smear
and become illegible.
7.) The Former and New Land Descriptions on sheet 2 shall be altered on the mylar as follows: Lot 7 and Lot 8
need to reference the original plat recording V/P then list the plat alteration V/P.
8.) CONSISTENT WITH RCW 84.56.345, AND RCW 58.08, CURRENT YEAR AND ALL DELINQUENT
PROPERTY TAXES INCLUDING COMPENSATING TAX FROM OPEN SPACE PROGRAM SHALL BE PAID IN
FULL PRIOR TO RECORDING THE STATEMENT OF INTENT.
9.) Upon issuance of this decision and provided there are no appeals of said decision, the applicant/surveyor shall
be responsible to have an amended mylar prepared with suggested revisions, according to the county and state
regulations and submit seven (7) paper copies of said mylar to this department for distribution and review by
county agencies. Applicant is responsible for submitting mylar recording fee payable to the Jefferson County
Auditor at time of submittal of mylar. Certificates for signatures by the Jefferson County Department of Public
Works, Jefferson County Environmental Health Department, Jefferson County Department of Community
Development, Jefferson County Treasurer, Chairman Jefferson County Board of Commissioners, and Clerk of
the Board shall be depicted on the face of the amended plat.
10.) An updated plat certificate or supplement shall be submitted with the final blueline and shall be 30 days current.
11.) Consistent with JCC 18.40.360(2)(b), any appeal of this decision must be in writing within fourteen days of said
decision.
Consistent with JCC 18.40.360(5) the appeal must comply with the following procedures:
1) A notice of appeal shall be delivered to the Administrator by mail or by personal delivery, and must be
received by 4:00 p.m. on the last business day of the appeal period, with the required appeal fee of $956
pursuant to the Jefferson County Fee Ordinance;
2) The name, address and phone number of the appellant and his/her interest in the matter;
3) Appellant's statement describing standing to appeal (i.e., how he or she is affected by or interested in the
decision);
4) The specific reasons why the appellant believes the decision to be wrong. The appellant shall bear the
burden of proving the decision was wrong;
5) The desired outcome or changes to the decision;
6) A statement that the appellant has read the appeal and believes the contents to be true, signed by the
appellant.
Any notice of appeal not in full compliance with the above procedures shall not be considered.
FINDINGS:
1.) The Administrator finds that this application complies with applicable provisions of the Unified Development Code, all other
applicable ordinances and regulations, and is consistent with the Jefferson County Comprehensive Plan and Land Use
map.
2.) This approval is for a plat alteration to adjust lots lines (including open space) and shift the road right-of-way
only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances
and does not preclude review and conditions which may be placed on future permits.
3.) The purpose of the plat alteration is the realignment of the easement for Whitney Road and to adjust lot lines
for lots 7, 8 and Tract A to create more buildable lots for the Lagoon View Long Plat.
4.) The proposed plat alteration conforms to all applicable county, state and federal land use, environmental and
health regulations and plans, including but not limited to the Jefferson County Comprehensive Plan and the
provisions of the Unified Development Code.
5.) Possible significant adverse environmental impacts of the proposed plat alteration have been considered and
determined the alteration will not result in an unacceptable adverse effect upon the quality of the environment.
6.) Approval of the proposed plat alteration will serve the public use and interest and provide provision for
maintaining the public health, safety and general welfare.
7.) None of the notified lot owners within the Lagoon View Long Plat nor any party of interest requested a public
hearing regarding this plat alteration. Consequently, no notice of public hearing has been given.
8.) The Department of Community Development sent notice to all lot owners within the Lagoon View Long Plat and
within 300 feet of the plat boundaries. The WA State Department of Archaeology and Historic Preservation,
Quilcene School District, Fire District #2, Jefferson County PUD, Jefferson County Sheriffs Department,
Skokomish Tribe, Point No Point Tribe, Suquamish Tribe, Jamestown S'Klallam Tribe, and Port Gamble
S'Klalam Tribe. The notice was mailed on July 5, 2016.
Notice of application was published in the July 6, 2016 edition of the Port Townsend Leader.
The notice was posted at the site on July 5, 2016 per signed and notarized Affidavit of Posting.
9.) The application was routed for review by the Jefferson County Assessor's Office, Public Works Department,
and Envrionmental Health Department.
Jefferson County Assessor's Office submitted comments on July 7, July 15, December 14, and December 16,
2016 and are hereby incorporated by reference.
Jefferson County Health Department submitted comments on August 31, 2016 and January 24, 2017 and are
incoporated by reference.
Jefferson County Public Works Department submitted comments on July 13 and December 8, 2016 and are
incorporated by reference.
10.) Written comments were recieved from Nicholas R. Knapton dated July 15, 2015 as follows:
"Our family has enjoyed many years as neighbors of Applicants, and we continue to own and enjoy lot adjacent
to the lots subject to the proposed adjustment. I have reviewed the notice and documents provided to our family
regarding the application, and I just wanted to submit this brief comment on the application.
I believe this application should be approved. The proposed adjustments to Lots 7, 8, and Open Space Tract A
in the plat would make sense for this subdivision, and I do not see any negative impact on adjacent property,
nor any other reason to deny the adjustment. Please always feel free to contact me if you have any questions."
11.) David Brownell with the Jamestown S'Klallam Tribe submitted comments dated July 7, 2016 that they would
defer to the Port Gamble S'Klallam with respect to cultural resources.
12.) Jefferson County determined that this proposal is categorically exempt from review under the State
Environmental Policy Act (SEPA) pursuant to WAC 197-11-800(6)(f).
13.) The original Lagoon View Long Plat was recorded under Auditor's File Number 406492, Volume 7, Pages
84-86, Records of Jefferson County, Washington.
14.) The parcel has been designated as Rural Residential 1 Dwelling Unit per 5 acres (RR1:5) under the Jefferson
County Comprehensive Land Use Map effective August 28, 1998.
15.) The application was reviewed by the Jefferson County Department of Community Development staff on April
26, 2016 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the
Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an
investigative site inspection, the following ESAs were confirmed to be present on the subject property:
geologically hazardous area, non -fish habitat stream, wetlands, fish and wildlife conservation area, susceptible
aquifer recharge area, coastal seawater intrusion zone.
16.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow
percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic
formations that contain sufficient saturated permeable material to yield significant quantities of water to wells
and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson
County.
17.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid
infiltration of recharge waters to groundwater aquifers.
18.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and
groundwater that may combine to create problems with slope stability, erosion, and water quality during and
after construction or during natural events such as earthquakes or severe rainstorms.
19.) Jefferson County has determined that the use of real property for agriculture and forestry operations is a high
priority and favored use in the county. The county will not consider to be a nuisance those inconveniences or
discomforts arising from such operations, if such operations are consistent with commonly accepted best
management practices in compliance with local, state, and federal laws. If your real property includes or is
within five hundred (500) feet of real property designated as Rural Residential 1:10 or 1:20, Rural Industrial,
Rural Commercial, Agriculture, or Forestry, you may be subject to inconveniences or discomforts arising from
such farming and forestry operations, including but not limited to noise, tree removal, odors, flies, fumes, dust,
smoke, the operation of farm and forestry machinery during any 24-hour period, the storage and disposal of
manure, and the application of permitted fertilizers and permitted pesticides. One or more of these
inconveniences may occur as a result of agricultural and forestry operations which are in conformance with
existing laws and regulations.
20.) Marine shorelines and islands are susceptible to a condition that is known as seawater intrusion. Seawater
intrusion is a condition in which the saltwater/freshwater interface in an aquifer moves inland so that wells drillec
on upland areas cannot obtain freshwater suitable for public consumption without significant additional
treatment and cost. Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of
the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals (primarily
through wells). The Washington Department of Ecology is the agency with statutory authority to regulate
groundwater withdrawal for individual wells in Jefferson County. New development, redevelopment, and land
use activities on islands and in close proximity to marine shorelines in particular should be developed in such a
manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent
possible by infiltrating stormwater runoff so that it recharges the aquifer.
21.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according to the County GIS
map. There are voluntary and mandatory measures identified in the Jefferson County Seawater Intrusion Polic}
(Resolution 61-02, effective September 23, 2002) that apply to well drilling proposals and building permit
applications on existing lots of record.
A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine shoreline, but no history of
chloride concentration above 100 mg/L in groundwater sources within 1000 feet.
22.) Jefferson County has determined that the use of real property for agriculture and forestry operations is a high
priority and favored use in the county. The county will not consider to be a nuisance those inconveniences or
discomforts arising from such operations, if such operations are consistent with commonly accepted best
management practices in compliance with local, state, and federal laws. If your real property includes or is
within five hundred (500) feet of real property designated as Rural Residential 1:10 or 1:20, Rural Industrial,
Rural Commercial, Agriculture, or Forestry, you may be subject to inconveniences or discomforts arising from
such farming and forestry operations, including but not limited to noise, tree removal, odors, flies, fumes, dust,
smoke, the operation of farm and forestry machinery during any 24-hour period, the storage and disposal of
manure, and the application of permitted fertilizers and permitted pesticides. One or more of these
inconveniences may occur as a result of agricultural and forestry operations which are in conformance with
existing laws and regulations.
23.) This parcel is within a no shooting area per JCC 8.50.
24.) NOTICE: This permit does not excuse the proponent from complying with other local, state, and federal
ordinances, regulations, or statutes applicable to the proposed development, but consistent with RCW 90.58.
Development pursuant to this permit shall be undertaken subject to the applicable policies and performance
standards of the Jefferson County Shoreline Management Master Program and the Jefferson County Unified
Development Code.
If during excavation or development of the site an area of potential archaeological significance is uncovered, all
activity in the immediate area shall be halted, and the Administrator shall be notified at once.
The Federal Endangered Species Act rules to protect threatened Chinook and Summer -run Chum salmon
became effective on January 8, 2001. Bull trout have been listed as threatened since early 2000. Under the
ESA, any person may bring lawsuit against any individual or agency that "takes" listed species (defined as
causing harm, harassing, or damaging habitat for the listed species). In addition, the National Marine Fisheries
Service can levy penalties. Portions of Jefferson County, including marine environments are included as
"critical habitat" for listed species. Development of property along any marine shoreline, freshwater shoreline,
or floodplains could harm habitat if protective measures are not taken. To minimize the potential to damage
habitat, all property owners developing adjacent to marine shoreline, freshwater shoreline, or floodplains are
advised to do the following:
- All development activities should avoid unstable slopes, wetlands, and forested areas near surface waters
- Remove minimal vegetation for site development, especially large trees
- Allow trees that have fallen into surface waters to remain there
- Infiltrate stormwater from buildings and driveways onsite through drywells rather than discharging directly into
surface waters or roadside ditches
The Federal Bald and Golden Eagle Protection Act requires landowners within 660 feet (1 /8th of a mile) of an
eagle nest to consult with the US Fish and Wildlife Service. This Eagle Act prohibits anyone from "taking" bald
eagles. This federal law defines the term "take" and describes the possible legal consequences when a "take"
occurs. Among other actions, "take" includes a disturbance of bald eagles or their habitat. Under federal law a
permit may still be required for activities that impact bald eagles or their habitat. Contact the US Fish and
Wildlife Service (http://www.fws.gov/pacific/eagle/) to learn more about how this law affects your project.
Any individual, group, or agency can bring suit for a listed species "taking", even if you are in compliance with
Jefferson County development codes. The risk of a lawsuit against you can be reduced by consulting with a
professional fisheries habitat biologist, and following the recommendations for site development provided by the
biologist. For more information, contact the National Marine Fisheries Service in Seattle, or the U.S. Fish and
Wildlife Service.
APPEALS:
Pursuant to RCW 36.70C, the applicant or any aggrieved party may appeal this final decision to the Hearing Examiner within
fourteen (14) calendar days of the date of issuance of this land use decision. For more information related to administrative
appeals see JCC 18.40.330.
I ozz
May 08, 2017
U C Administ-rator Date
MLA16-00036
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street I Port Townsend, WA 98368
360-379-4450 1 email: dcd@co.jefferson.wa.us
Aennner rn iefferenn rein i is/rnmmrievelnnm nnf
\\tidemark\data\forms\F_MLT_IssuePerm it—U. rpt
5/8/2017
Page 5 of 5
gON DEPARTMENT OF CO
MMUN� VCLOPMENT
H K
621 Sheridan Street, Port Townsend, WA 98368 � ��
Tel: 360,379.4450 Fax: 360.379.4�11 r iI Wcb:�VF; mail: iisi��{1tc�..4` +n
APS
PERMIT APPLICATION}Sr�f
Steps in the Permit Process:,
-Review application checklist to ensure all information is completed prior to submitting application.
-Make sure septic has been applied for and water availability has been proven.
-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
Related Application #s: 5)0 6 ko —1
Building Permit #
MLA # I U —'Stc
Site Information
Assessor Tax Parcel Number: 996400001, 996400007, & 996400008
Site Address and/or Directions to Property: 1060 Whitney Rd Quilcene WA 9837
Access (name ofstreet(s)) from which access will be gained: Whitney Rd off of Coyle Rd
Present use of property: Residential
Description of Work (include proposed uses): Residential
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 pe of septic system below:
Type of Sewage System Serving Property:
X Septic Septic Permit#: SEP72-00042
Community Septic Name of System: _ Case #:
Are other residences connected to the septic system? No
Additions or repairs to sewage system:
Is it a complete or partial system installation: Complete X 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:
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 emall (i.e.,
Count email is not blocked or sent to Munk mall'I.
Applkant/Property Owner Information
Property Owner:
Name: Seaman Ventures, LLC C/O David W. Whitney
Address: 9817 Mona Lisa LN Bakersville CA 93312
Phone (_206)406-8084 E-mail Address: dwwhitnev@hotmail,nnTn
,/Representative with project info. (select only one).
Please contact Authorized tt
Pro P rtY e Ow!3nature: date; f"
Note: For projects with multiple o4ners, attach a separateLet with each owner(s) information and s1 at es.
Applicant: Authorized Agent/Representative (if other than owner)
Name: Northwestern Territories, Inc.
Address: 717 Peabody Port Anqeles WA 98362
Phone M (';An) 4(�?— R 4 q l E-mail Address:
Professional: Is this an Authorized A4ent/Representative for this project? NO - _YES
X
Engineer Architect Surveyor X Contractor Consultant
Name: Kent L. Robinson License# 19583
Address: 717 Peabody Port Angeles WA 98362
Phone #: (360)452-8491 E-mail Address: kRnt- (an ti4u.com
Professional: Is this an Authorized Agent/Representative for this project? NO
YES
Engineer Architect Surveyor Contractor Consultant
Name: License #
Address: _
Phone #: E-mail Address:
Professional: Is this an Authorized ent/Representative for this project? NO
YES
Engineer Architect Surveyor Contractor Consultant
Name: License #
Address:
Phone M 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 o€the ;County's intent to enter upon the property for visits related to this application and subsequent permit issuance.
: .� Print Narne: ?urs . ilt��c Date: JV f ,
Signature: _ t l„!. c _.��
�gON c'o DEPARTMENT OF CO IST MU N T'T'Y DEVELOPMENT
41 621 Sheridan Street, Port'I'ownsend, WA 98368
Tel: 360.379.4450 Fax: 360.379.4451 �' � v-
S
Web:..
E-mail:�� �' n,
�s �0 �, �
LINO 4Ajp
PERMIT APPLICATION`y,�
. _- ps in the Permit Process: }
-Review application checklist to ensure all information is completed prior to submitting application.
-Make sure septic has been applied for and water availability has been proven.
-Make an appointment to meet with the Permit Technician by calling 360-379-445u.
-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: '2>L% Pik G 1 MLA ##
1 51te Information
Assessor Tax Parcel Number: 996400003, 996400004, 996400005, 996400010, & 996400011
Site Address and/or Directions to Property
0 Whitney Rd Ouilcene WA 98376
Access (name of street(s)) from which access will be gained: Whitney Rd off of Coyle Rd
Present use of property: Residential
Description of Work (include proposed uses): Residential
Wastewater - Sewage Dispose! _
This property is served by Port Townsend or Port Ludlow sewer system?
If not served by sewer identified above, identify type of septic system below:
YES NO X
Type of Sewage System Serving Property:
Septic Septic Permit#: SEP -000
Community Septic Name of System: Case #:
Are other residences connected to the septic system? No
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:
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.,
County email is not blocked or sent to "iunk mail").
Applicant/Property Owner Information
Property Owner:
Name: John Whitney
Address: 2744 Lariat LN Wallnut Creek CA 94596
Phone #: 933-8943 E-mail Address: 1' ack
whitnev hnt rng i 1 : rr)m
—(925)
Please c tact Authorized Agent/Representative with project info. (select only one).
� ii�^
Property Owner Signature: y �• Date: VD `—' i L 240tiS
Note: For projects with multiple owners, attach a separate sheet with each owner(s) information and signatures.
Applicant: Authorized Agent/Representative (ifotherthan owner)
Name: Northwestern Territories Inc.
Address: 717 Peabody Port Angeles WA 98362
Phone #: (360)_452-8491 E-mail Address:
Professional: Is this an Authorized Agent/Representative for this project?
NO YES X
-
Engineer Architect Surveyor X Contractor
Consultant
Name: Kent L. Robinson License#
19583
Address: 717 Peabody Port Anqeles WA 98362
Phone (360) 452-8491 E-mail Address: trent
nti4u.com
Professional: Is this an Authorized Agent/Representative for this project?
NO YES
Engineer Architect Surveyor Contractor
Consultant
Name: License #
Address:
Phone #: E-mail Address:
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 witn
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 the County's intent to enter upon the property for visits related to this application and subse uent permit issuance.
l �1� r`
Signature: . Print Name: �`' Date: -
-$ON DEPARTMENT OF COMMUNE VELOPMENT
621 `;hcrivan Sucer, I'urt'fc,wnsencl, W" 1 98.368 �-
t ol. 30.379 4450 11 N x: 360.379.445 1
11 qtr �4�W r+' • f •r.,u s tt;r, r { ;vck, ' � �"
I. Sys [flail. 01?
PERMIT APPLICATION "�'%0()
Steps in the Permit Process:
-Review application checklist to ensure all information is completed prior to submitting application.
-Make sure septic has been applied for and water availability has been proven.
-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.
j For Department Use Only Building Permit #
Related Application #s: 5U 1*," ->l (p } MLA .# (Q
Site Information
Assessor Tax Parcel Number: 996400002, 996400006 & 996400009
Site Address and/or Directions to Property:
1341 Whitney Rd Ouilc:ene WA 98376
Access (name of street(s)) from which access will be gained
Present use of property: Residential
Description of Work (include proposed uses):
Wastewater - Sewage Disposal
This property is served by Port Townsend or Port Ludlow sewer system? YES NO
If not served by sewer identified 'a bove, identify type of septic system below:
Type of Sewage System Serving Property:
X _ Septic Septic Permit#: SEP70-00037
Community Septic Name of System: Case #:
Are other residences connected to the septic system? No
Additions or repairs to sewage system:
Is it a complete or partial system installation: Complete _ X Partial
Has a reserve drainfield been designated? Yes _ No
D f
Whitney Rd off of Coyle Rd
Residential —
X
ate o 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:
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.,
r'nunr» -mail is not hlnrkari nr cant to %ink mail"l
Applicant/Property Owner Information
Property Owner:
Name: Mary Ann Whitney—Hall
Address: 1240 Swiftshore Circle, West Linn, OR 97068
Phone#: (503)334-7965 E-mail Address: mwhitnev—hall Gnmcast_net
Please contact Authorized Agent/Representative with project info. (select only one). 7
Property Owner Signature: W Date: AGf �0
Note: For projects with multiple owners, att h a separate sheet with Oh owner(s) information and signatures.
Applicant: Authorized Agent/Representative (If otherthan owner)
Name: Northwestern Territories Inc.
Address: 717 Peabody Port Anqeles WA 98362
Phone#: (360)452-8491 E-mail Address:
Professional: Is this an Authorized Agent/Representative for this project? NO YES X
Engineer Architect Surveyor X Contractor Consultant
Name: Kent L. Robinson License# 19583
Address: 717 Peabody Port Angeles WA 98362 _
Phone#: (360)452-8491 E-mail Address: kentPnti4u.c:::1
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer Architect Surveyor Contractor Consultant
Name: License #
Address:
Phone #: E-mail Address:
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 t e Co u in to t upon the property for visits related to this application and subsequent permit issuance.
Signature: Print Name*�vJ`!/. Date: /�
�4$,pitil,:,...'.j
LU DEPARTMENT OF COMMUNITY DEVELOP q4,
621 Sheridan Street, Port Townsend, WA 98368
Tei: 360.379.4450 1 Fax: 360.379.4451'b
Web: www.4o.'efferson.wa.us cammunit develo ment APR 9
E-mail: dcd@co.0efferson.wa.us
® O
IN 0
SUPPLEMENTAL APPLICATION'" Cp
PLAT VACATION/ALTERATION�,ir
MLA # PROJECT/APPLICANT NAME: David Whitney
Submittal Requirements Lagoon View Long Plat Alteration
1. A completed Master Permit Application. Representative authorization is required if application is not signed by owner.
2. Plat Alteration/vacation fee, as set forth in the Jefferson County Fee Ordinance, as amended.
3. Current title company certification/plat certificate.
4. a. For a plat vacation, signatures of all parties having an ownership interest in that portion of the short plat, long plat, or
binding site plan subject to the proposed vacation; or
b. For a plat alteration or replat, signatures of a malon[k of those parties having 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 residential
development (PRRD) agreements, or other encumbrances 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 vacation(s) depicted in red ink.
7. Any additional information reasonably deemed necessary by the Administrator to evaluate the proposed alteration or vacation.
8. Describe the proposed alteration(s) or vacation(s) 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 because of the slope to the west. Open
space size will not change because 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 (F) 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 covenant(s) providing that the parties agree to terminate or alter the relevant
covenant(s) to accomplish the purpose of the alteration or vacation of the plat or binding site plan, or portion thereof.
0 Yesl No
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?
0 Yes � No
Page 1
13. Is any land within the proposed alteration or vacation within the limits of an assessment district?
OYes i 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?
Yes O 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 applicant(s) hereby acknowledges that any permit issued on this
appI' NY ere ifwr>u h statement is found to be false. 9 9 6 4 0 0 0 0 7
* 996400001 March 24, 2016
David Whitney996400008
APPLICANT'S SIGNATUR ND P,�, EL NUMBER) 996400003 996400010 DATE
* 996400004 996400005 March 24, 2016
John Whitney 996400011
r` PROPERTY OWNER'S SIGURE {+IC1ARCEL NUMBER) 6 4 U U La {)
*Mary 996400009
Whitney -Hall 996400002
PROPERTY OWNER'S SIGNATURE (AND—PARCEL NUMBER)
*
John Nelson 601342019
PROPERTY OWNER'S 5 GNATURE (AND PARCEL NUMBER)
PROPERTY OWNER'S SIGNATURE (AND PARCEL NUMBER)
DATE
March 24, 2016
DATE
March 24, 2016
DATE
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)
Page 2