HomeMy WebLinkAboutCAR1997-00350 . .
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JEFFERSON COUNTY BUILDING APPLICATION
Jefferson County Permit Center Stormwater Plan
Castle Hill Mall
Sheridan St. RequireJ
Port Townsend, WA 98368
360-379-4450
PERMIT # •BLD97-0810 18 r DATE RECEIVED. : 12/22/97
SITE ADDRESS:224 MATS VIEW TERRACE DR
:PORT LUDLOW, WA 98365 {%49.a
APPLICANT. . . :DON SAUNDERS iViaTT AcuLy6 PHONE: (360) 437-5146
MAILING ADDR: 224 MATS VIEW TERRACE ki50.
:PORT LUDLOW WA 98365
CONTRACTOR. . :OWNER PHONE:
MAILING ADDR:
CONTR. LIC #: EXPIRATION DATE: / /
ARCHITECT/ . . : PHONE:
DESIGNER •
MAILING ADDR:
c.--1?/ .
0 ''
PARCEL NO. : 970900009 U landslide plat cond _ wetland i) flooding /'VC
LEGAL DESC:STR 05-28-01 E WM seismic _ __streams? erosion, / " f & w j .
LOT 9, BLOCK , TAX # ,` v
MATS VIEW TERRACE '7- �-IWI r ta‘ 4444 �`
gbOrr
DESCRIPTION OF IMPROVEMENT: Single family residence..
BUILDING TYPE *RES BEDROOMS--- BATHROOMS-- MAIN FL. . . : 862 sf
TYPE OF IMPROVEMENT:NEW EXIST. : 0 EXIST. : 0 ADD'L FL. . : 1878 sf
GARAGE/CARPORT •A PROP. . : 3 PROP. . : 3 HTED BSMT. : 0 sf
WOODSTOVE • TOTAL. : 3 TOTAL. : 3 UNHT BSMT. : 0 sf
UBC OCCUPANCY GROUP: SEWAGE DISP. . :ALT OTHER • 0 sf
TYPE OF CONST • WATER SUPPLY. :PUD CRPT/GAR. . : 1115 sf
UNITS. : 0 STORIES: 2 HEAT TYPES. :PRO/ / DECKS • 189 sf
DIMENSIONS: COMMERCIAL: 0 sf
FRAME TYPE:WOOD INDUSTRIAL: 0 sf
EST COST. $: 156065 BANK HT. . . : 0 ft
PROJ GRP. . : 10189 SH SETBACK: 0 ft
Owner/agent FEES
Signature: type amount by date recpt
PRMT $ 1172 . 00 EMH 12/22/97 1142366
Date: PLCK $ 351. 68 EMH 12/22/97 1142366
B.C. $ 4 . 50 EMH 12/22/97 1142366
Issued By:
Date:
i � $ 1528 . 18 TOTAL
///�
AS
•
SEWAGE DISPOSAL PERMIT APPLICATION
JEFFERSON COUNTY PERMIT CENTER
621 SHERIDAN STREET, PORT TOWNSEND, WA 98368 (360) 379-4450
DATE RECEIVED/REVISED: 12/22/97 PERMIT NUMBER:SEP97-0309
Application to CONSTRUCT, ALTER, REPAIR OR MODIFY A SEWAGE DISPOSAL SYSTEM
IN JEFFERSON COUNTY, WASHINGTON
OWNER PHONE: (360) 437-5146
ISSUED TO • DON SAUNDERS
MAILING ADDRESS. . : 224 MATS VIEW TERRACE
: PORT LUDLOW WA 98365
INT PHONE:
INTERESTED PARTY. :
MAILING ADDRESS. . :
•
DESIGNER •
MAILING ADDRESS. . :
PARCEL NUMBER • 970900009 STR: 05-28-01E
(Permit valid for this/these parcel (s) ONLY)
LEGAL DESCRIPTION/SUBDIVISION: MATS VIEW TERRACE BLOCK:
LOT(S) : 9
LOCATION • 224 MATS VIEW TERRACE DR
TYPE OF SYSTEM: TANK ONLY
TYPE OF WORK : NEW ii
ASSIGNED TO: LINDA � i ; � `'F,
FEE: TANK $ 103 . 00 EMH 12/22/97 1142366 PieVielokilACO
Stagyr! &rEMPs
STORMWATER YES NO Requir d-i :6_
wetland erosion seismic streams
flooding _ landslide _ f & w _ plat cond
sep _app .txt 07/10/93
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Jefferson County Permit Center Date
621 Sheridan Street Fee
Port Townsend WA 98368 Rec #
CRITICAL AREAS QUESTIONNAIRE Ck #
Case #
Applicant Name S A - N T 5
•
-3uilding Application — Land Use Application — Shoreline Application
On-site Sewage Application — Subdivision Application — Other:
1 . Is there any standing or running water on the surface of the YES NO
property or on any nearby property at any time during the year?
If YES, please describe: 5 u f=ry G e c4 oU .!,FF
2. Has any portion of the property or any nearby property ever been YES -\1-0
identified as a wetland or swamp?
If YES, please describe:
3. Are any willows, skunk cabbage, alders, or cottonwoods present YES NO
on your property or adjacent properties?
If YES, please describe:
4. Are there any indications on any portion of the property or on any YES '"v
nearby property of rockslides, earthflows, mudflows, or landslides?
If YES, please describe:
5. Please indicate which line best represents the steepest slope found
on your property. (Check appropriate box)
p a 4 4 a o ,0
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_ .............
-'�•�" '-- (Questionnaire Continues on Back)
6. Does the site have steep slopes with little to no vegetation? YES
If YES, please describe: •
7. Does the site contain high percentages of silt and/or very fine YES -10
sand?
If YES, please describe:
8. Does the site contain ground water seepage or springs near the YES NO
surface of the ground?
If YES, please describe: / lI-) k_c CO
The applicant hereby certifies that all of the above statements and the information contained in any other
transmittals made herewith are true, and the applicant acknowledges that any action taken by Jefferson
County based in whole or in part on this application may be reversed if it develops that any such statement
or other information contained herein is false.
Signature Date -7D_
`7
FOR OFFICE USE ONLY
❑ Wetlands ❑ Seismic
CRITICAL AREAS ON OR ❑ Aquifer Recharge Area (zone_) ❑ Fish & Wildlife Area 1
IMMEDIATELYADJACENTTO SITE: ❑ Frequently Flooded Area ❑ Fish & Wildlife Area 2
❑ Erosion
❑ Landslide
Zone:
Parcel Size: Status:
Comprehensive Plan Land Use Designation: Reviewed by:
Community Plan: Date:
Owner/Applicant: STORMWATER CALCULATIONS
• ))0N '4 V 514M/88k) E7. 5
Site Address: 2-2--4 r -rS PROPOSED LAND DISTURBING ACTIVITY
Drainfield area cleared sq.ft.
PD /2,7— tI>L--011/ , 4:1933(o Driveway Length ft.
9 Digit Parcel Identification No.: °17 0 — FDD—, 001 X Width ft.
Pe9rn 1—ONumo I —H / —05'1 Dog-g J -�0`''--o/. = Total Driveway 3 7 7 .3 sq.ft.
Clearing and Grading for Site Development
(Well/Structures/Utilities/etc.) sq.ft.
Total Land Disturbance sq.ft.
PLOT PLAN
INDICATE the following information.
❑ IMPERVIOUS SURFACE
Draw entire parcel to scale. Indicate scale of plot plan:
ft ,
Proposed Structures (all roof area) ' sq.ft.
One inch equals Z_Q -Q
Existing Structures (all roof area) sq.ft.
Sidewalks I Lit sq.ft.
1. North arrow
Concrete Patios sq.ft.
. 2. All property boundaries and dimensions
Proposed
)l' 3. Names of adjacent streets
Driveway Length ft.
I" 4. Driveway/s & parking spaces X Width ft.
5. Major features such as ravines, -�
= Total Driveway / sq.ft.
seasonal creeks, bodies of water, etc.
Total Impervious Surface /p D Z S sq.ft.
6. Septic tank and drainfield location,
existing or proposed, and distance to The Stormwater Manual sets forth the following Small
Parcel Minimum Requirements:
closest structure • Construction Access Route Stabilization:
0 7. Sewer lines Construction vehicle access shall be, whenever feasible,
limited to one route. Access points shall be stabilized with
❑ 8. Wells and/or water lines quarry spalls or crushed rock to minimize the tracking of
❑ 9. Neighboring wells within 150 feet sediment onto public roads. If sediment is inadvertently
transported onto public roads, roads shall be cleaned
, 10. Paved surfaces (patios) thoroughly at the end of the day by shoveling or sweeping.
, '1 1. Structures, existing and/or proposed Street washing should only be done after the bulk of the
sediment has been removed by sweeping.
,k12. Setbacks (distances to property • Stabilization of Exposed Soil:
boundaries, structures, banks, All exposed and unworked soil shall be stabilized by
sodding, seeding, mulching, plastic covering, application of
and shorelines) gravel base on roads and driveways, or other appropriate
means within seven days during the period from May 1 to
; '13. Easements for access or utilities
September 30 and within two days during the period from
.'14. Arrows showing direction of slope-- October 1 to April 30. Mulch shall be applied to a minimum
assume an elevation of 100 feet at one depth of two inches.
• Protection of Adiacent Properties:
lot corner and indicate the other lot Adjacent properties shall be protected from sediment
corner elevations in relation to it deposition by appropriate use of vegetative buffer strips,
sediment barriers or filters, dikes, mulching, or by a
combination of these measures and other appropriate Best
FOR APPLICATIONS ADJOINING SHORELINES, Management Practices (BMPs).
INDICATE: • Maintenance:
All erosion and sediment control BMPs shall be regularly
❑ 15. Ordinary high water mark inspected and maintained to ensure continued performance
❑ 16. Top of bank, if over 10 feet high of their intended function.
• Other Appropriate BMPs as required by Jefferson
❑ 17. Slope of bank in degrees County to mitigate the effects of increased runoff shall be
applied.
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�4 JEFFERSON COUNTY PERMIT CENTER
621 Sheridan Street, Port Townsend, WA 98368
qso
-tfING 3"
January 12, 1998
Mr. Don Saunders
224 Mats View Terrace
Port Ludlow, Washington 98365
Re: Application No. BLD97-0810
Dear Mr. Saunders,
Upon review of the Jefferson County Building Application Permit Number SEP97-0114, it has been
determined that the following Jefferson County Interim Forest Lands Ordinance(Ordinance No. 01-0121-
97)applies to your property,due to the presence of Commercial Forest Lands on an adjacent property
(south). The ordinance reads as follows:
As explained in the Jefferson County Interim Forest Lands Ordinance (Ordinance No. 01-0121-
97), it is the policy ofJefferson County to conserve forest lands for productive economic use.
Accordingly, land use activities within or adjacent to designated forest land are expected to be
sited and designated to minimize conflicts with forest management activities. To implement
County policy, the buffer and development restrictions outlined below are required on property
adjacent to or within designated Commercial and Rural Forest Lands.
The following conditions apply:
7.20.S'itinc>of Structures Adjacent to Forest Lands
Builders o f new.structures proposed to be located on parcels adjacent to forest lands shall:
I. l..siahlish and maintain a minimum 250-foot building setback adjacent to Commercial Forest
Lands and 100 feet adjacent to the Rural Forest Lands designation, which shall serve as a
resource protection area. as measured from the property boundaries of adjacent forest lands
except as.follows:
a. If the size, shape, and/or physical site constraints of an existing legal lot do not allow
Qpa setback of 250 feet adjacent to Commercial Forest Lands and 100 feet adjacent to
/
the Rural Forest Lands designation, then the new structure shall maintain the
nra_rinnun setback possible; or
b. if the owner of the land on which the new structure is proposed and the owner of the
adjacent forest land each sign and file for record, in the manner required by law for
covenants running with the land, a document which establishes an alternative setback
for one or both of the properties, a setback of less than 250 feet adjacent to Commercial
Forest Lands and 10 feet adjacent to Rural Forest Lands may be maintained.
Building Environmental Health Development Review Public Works
Building Permits Septic Permits Subdivision, Zoning Road Approach
Inspections Water Review & Shoreline Permits Permits & Addresses
(360) 379-4450 FAX: (360) 379-4451
i
• Siting of Structures Adjacent to Forest Lands
Page 2
2. Submit a notice signed by the developing landowner and recorded with the title of the
developing property, which explains:
The ability of the forest land owner to practice forestry using management practices
as allowed under Title 222 WAG(see attachments);
0/
6 Provide adequate access forfire vehicles(see attachment); and
4. If the proposed structure is located within 200 feet of the boundary of the property designated
forest land, survey the property boundaries that abut forest land, locate the property
boundaries on the ground, and submit a record of survey with a building permit application.
You will be responsible for submitting the above listed bolded items prior to release of your building .
permit. If you have any questions please phone or stop by the Permit Center.
Sincerely,
I-0
Sue Theiss
Associate Planner
Jefferson County Permit Center January 27, 1998
621 Sheridan
Port Townsend WA 98368
(360) 379-4463
FINDINGS AND CONDITIONS OF APPROVAL AS REQUIRED UNDER THE
JEFFERSON COUNTY INTERIM CRITICAL AREAS ORDINANCE
Applicant DON SAUNDERS
Mailing Addr: 224 MATS VIEW TERRACE
PORT LUDLOW WA 98365
Critical Area Review Case NO. : CAR97-0350 BLD97-0810 SEP97-0309
Project Description: Single family residence
Parcel • 970900009 S-T-R: 05-28-01 E
Site Addr: 224 MATS VIEW TERRACE DR
PORT LUDLOW, WA 98365
FINDINGS
In accordance with the authority provided under subsection 4 . 101
and the requirements contained in Subsection 5. 402 of the Jefferson
County Interim Critical Areas Ordinance, the following are findings
of fact relating to the referenced application:
1) The application was reviewed by Jefferson County Permit Center
staff on 1-27-98 for the potential presence of critical areas regulated
under the provisions of the Ordinance, and the following critical areas
were confirmed as potentially present on the subject property:
landslide hazard, seismic hazard, adjacent commercial forest land.
2) Commercial forest lands are located on the western and southern
adjacent properties. According to the Jefferson County Interim Forest
Lands Ordinance (Ordinance No. 01-0121-97) , buffer and development
restrictions are required on property located adjacent to designated
commercial forest land. Please refer to the previously sent letter
regarding buffers and development restrictions for this property.
3) Designated long term forest lands are located on the southern and
western adjacent properties, on which a variety of forest related
activities may occur that are not compatible with residential
development. These activities include spraying, pruning, harvesting,
blasting, drilling, rock crushing, and vehicle movements, which can
generate dust, smoke, noise, and odor. Forest or mining activities
performed in accordance with county, state, and federal laws are not
subject to legal action as public nuisances.
4) The potential for an earthquake of a high magnitude occuring in
western Washington in the near future is considered a high probability
by regional experts.
5) 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.
This waiver from the provisions of the Jefferson County Interim Critical
Areas Ordinance is granted subject to the following conditions. Any
deviation from these conditions shall result in this waiver being
revoked and the application becoming subject to further review.
%
Page: 3
CAR97-0350
DON SAUNDERS
CONDITIONS OF APPROVAL
1) Vegetation retained on-site following completion of clearing for
roadways, utilities and the like, may be cleared only if such clearing
is absolutely necessary to complete the proposal (Note: This condition
shall not be construed as allowing removal of native vegetation within
a designated critical area or its associated buffer) .
2) The applicant shall develop and submit to the Permit Center for
approval, a "Small Parcel Erosion Control Plan" (see enclosures) . Once
the subject permit has been issued, the applicant shall fully implement
the provisions of the submitted "Small Parcel Erosion Control Plan. " A
Certificate of Occupancy will not be issued until the Permit Center
verifies plan compliance.
3) Development related permits will not be issued until required
forest land submittals are received and approved, as per Ordinance No.
01-0121-97 .
4) The proposed development shall be located on the subject property
exactly as identified on the Universal Plot Plan, or other Site Plan,
approved by the County as part of the triggering permit application.
Applica t shall be responsible for contacting and notifying
contrac or(s) of the above conditions in order to ensure compliance at
variou- sages of construction/development.
1 2t41g8
Al calf D o
Director of Comm. ity Development
I understand that the granting of the above waiver from the
provisions of the Jefferson County Interim Critical Areas
Ordinance is made subject to my complying with the above listed
conditions, and that any violation of said conditions shall
result in revocation of the permit or approval and further
review of the project under the Critical Areas Ordinance.
Please sig and return to the Permit Center.
cz;_v_73)
Applicant Dat
F_ - 3 1998
•
F 3
JEFFERSON COUNTY
STORMWATER MANAGEMENT ORDINANCE ._
SMALL PARCEL EROSION AND SEDIMENT CONTROL PLAN
EROSION AND SEDIMENT CONTROL WORKSHEET
Property Owner:DON Shtu wnEI . Telephone$34..00 I-137— 674-40
Address: 9 / // l c2? !/Lj(gz(/ p3/wfj]
Assessor's Parcel Number: q. I (9q 0 CI )
Building Permit or Septic Permit Application Number(if applicable):(, gf 1 -- (--)
550
Brief Project Description: re'
Site Location: 22 `-+" H I Vi,E1A) --Te-� C • ) • Lu DLt vJ ,
Person Responsible for BMP Installation and Maintenances Cccj
Address: / ,
Telephone:.3(...00 -- 4-37-5/ 4443,
1. Describe/check the Best Management Practices (BMPs) that you will implement during land
disturbing activities or construction to control erosion and prevent sediment from entering water
bodies (marine waters, streams, rivers, lakes, or wetlands) or impacting adjacent property or roads.
Please check the measures you plan to implement and show their approximate location on the site
plan. You may also propose measures other than those listed. Attach additional sheets, if more
space is required.
Stabilize construction access route. Limit construction vehicles to one route, if feasible.
,,V
Provide a stabilized construction access by applying quarry spalls, ballast, or crushed rock
to minimize tracking sediment onto roads. (See attached illustration from Stormwater
Management Manual.) If sediment is transported onto roads, they will be cleaned
thoroughly.
Minimize the extent of land disturbing activity and preserve existing vegetation.
Preserve buffers of well-established vegetation between disturbed areas and property
boundaries, roads, water bodies, and designated critical areas (wetlands, fish and wildlife
habitat areas, landslide or erosion hazard area, etc.).
March 10, 1997
3
EROSION AND SEDIMENT CONTROL WORKSHEET
X, Phase clearing so that only areas that are actively being worked are uncovered.
[] Start and complete land disturbing activities and stabilize the site between April 1 and
September 30. Stabilization means that disturbed areas will have well-established plant
,:cover or be landscaped to minimize erosion.
Stabilize exposed soil Exposed and unworked soil will be covered within 2 days between
October 1 and March 31 and within 7 days between April 1 and September 30.
[ ] Cover exposed soil with a minimum of 2 inches of straw or hay or other material
appy ved for this purpose.
Cover soil stockpiles with plastic sheeting and locate away from water bodies, roads,
and Tyoperty lines.
Place gravel base on roads, driveways, and parking areas after clearing and subgrade
preparation.
Protect adjacent properties and water bodies from sediment deposition:
] :
[] Place straw or hay bales in ditches and drainage ways down slope from areas
of land disturbing activity to filter runoff before it leaves the project site or enters
water bodies. (See attached illustrations from Stormwater Management Manual.)
5i5 J) Install a filter fence down slope from areas of land disturbing activity to filter runoff
(� before it leaves the project site or enters water bodies. (See attached illustration from
03P . Stormwater Management Manual.)
] Regularly inspect and maintain all BMPs especially after storms events.
'-/ Describe other erosion and sediment control Best Management Practices. Be specific
as to design and specifications.
t 1�� ,4 . f . ix, PAll'E •; _ , ir:_.: ,_,.
March 10, 1997
4
•
EROSION AND SEDIMENT CONTROL WORKSHEET
2. Describe how disturbed areas will be permanently stabilized (seeded, landscaped, apply gravel base
to roadways, etc.)
3. Describe how runoff from impervious surfaces will be controlled (disperse to vegetated areas to
infiltrate, dry well, infiltration trench, route runoff to existing drainage facilities, etc.).
5b(erp
y
LOE
March 10, 1997
5
EROSION AND SEDIMENT CONTROL WORKSHEET
4. Specify your construction sequence. Describe the timing of all land disturbing activities (clearing
and grading, construction, installation of drainage facilities, landscaping, etc.) and Best
Management Practices. Describe proposed maintenance of BMPs.
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The Best Management Practices proposed above will be implemented to control erosion, sediment, and
_ormwater runo►. I will notify the Permit Center for inspections as required.
_ _ _QAM
Signa ure of Owner/Agent Da
h:\home\pincntr\storm\wksheet.doc
March 10, 1997
6
• .
.STOP_MWATER MANAGEMENT MANUAL FOR THE PUGET SOUNT BAS:N
Figure II-5.20 Proper Installation of a Straw Bale Barrier
1 . Excavate the trench . 2. Place and stake straw bales .
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3. Wedge loose straw between 4. Backfill and compact the
bales . excavated soil .
CONSTRUCTION OF A STRAW BALE BARRIER
4
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Points A should be higher than point B
•
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PROPER PLACEMENT OF STRAW BALE BARRIER IN DRAINAGE WAY
II-5-82 FEBRUARY, 1992
STORMWATER MANAGEMENT MANUAL FOR THE PUGET SOUND BASIN
Figure II-5.19 Cross-Section of a Properly Installed Straw Bale Ba--; =-
Staked and Entrenched
Straw Bale
Binding Wire Coroacted Soil to
or Twine I� ' I Prevent Piping
I 1� (I � I Sediment Laden
Filtered Runoff ' i l\ 1i Runofi�i I�, : •
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.... ,; — , I_ \\\\
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ST( RiWATER MANAGEMENT MANUAL FOR THE PUGET SOUND BASIN DRAFT
Figure I1-5.18 Filter Fabric Fence Detail
Filter fabric material in continuous rolls;
Use staples or wire rings to attach fabric
to wire
Wire mesh support fence
for slit film fabrics
n n
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i { Bury bottom of filter material { {
{ in 8" by 12" trench i {
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+►-- 2' by 2' wood posts,standard or better { •
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Wire mesh support fence 1
for slit film fabrics 4
Filter fabric i e
material
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CV
Provide washed gravel «�7�!'� -/•
backfill or compacted
native soil as directed
M..L
by local government
Bury bottom of filter material+ 8" Min.
in 8'by 12' trench
2'by 2' wood poets,standard or better
or equivalent
•
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II-5-78 FEBRUARY, 1992
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STOR'iriATER MANAGEMENT ;4. -NUAL FOR TF.F. PUGET SOUK BASIN
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153
4" to 8" quarry spalls
provide full width of
ingress/egress area
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II-5-31 FEBRUARY, 1992
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RE: BUILDING PERMIT APPLICATION NO.BLDG 7 0810
PROPERTY OWNER(S)(Please Print)
DAt-) R . k" Yt Vt A-NNE M. 5 A-titNDER
LEGAL DESCRIPTION
L o T" g OF rri 4TS Y I E / AS PE, P1-47-
R c-0R-D
Z4TREc_0RD VoLuttitn) -7, OF Pi-AFTS (PA 6Es Co. 3- Io5
SITE ADDRESS
z-z-4 eon A-Ts V 1 EhJ 1 t<4
PO fzT" LLA.D Lp t )/ W '1 8 3b5
CONSISTENT WITH THE REQUIREMENTS OF JEFFERSON COUNTY INTERMIN FOREST
LANDS ORDINANCE(ORDINANCE NO. 01-0121-97), I AGREE TO PROVIDE ADEQUATE
ACCESS FOR FIRE VEHICLES TO THE AFOREMENTIONED PROPERTY.
SIGNATURE OF EACH PROPERTY OWNER
5
/AI/ ► ��
This form does not need to be notarized
Please return to: Jefferson County Permit Center,621 Sheridan Street,Port Townsend, Washington
98368
Rk OROEU IN 60,/
OFOOFFICIA RECORDS
REQUEST OF
9ti_tumt
-jHI
DONNA 11. GACTFIELD
NO REAL ESTATE JEFFERSON COUNT Y AUDITOR
SALES TAX REQUIRED ,
�' ' ►DEPUTY
COUNTY TREASURER BY - '•T/
BY SO-VA-n- 0— ,
When recorded return to: 4O`7 86
Name: V I V I A-N N Stetvt N D�hS
Address: Z-2-Lf ell'T V 1ST/ D
City: Po r.J .
State, Zip: Nig • '. 8 3 t'
cc ,Permit Center
NOTICE TO TITLE
Grantor(s): (Last, First and Middle Initial of each property owner)
S MAW bEies , Do Nff-t_p /Z•
SA-cut)DE�s V( VtA•NNE •
Additional grantor(s) on page
Grantee(s):
The Public
DESCRIPTION OF REAL PROPERTY AFFECTED:
Lot , Block , of
Section S , Township R_$ N, Range / E WM.
1 07 R )714-7S VIEW 7 ER R c-E ,
4S PEN_ pL.4.7- RE LORD ,
V o L Iti An N 7 a6 PL ATS X4-6 czs 6,3 -60 5
Additional legal description on page
ASSESSOR'S TAX PARCEL NUMBER: R7 V — l a D "D 01
Additional parcel numbers on page
As the property owner of the aforementioned parcel, I have requested a permit to construct a:
)( Residence Other Structure (
from the Jefferson County Department of Community Development. I have been informed
that as of the date listed below, there is a parcel(s) adjacent to my parcel which is designated
by Jefferson County as Forest Lands of Long Term Significance in accordance with RCW
36.70A.050 as codified in Chapter 365-190 WAC. Furthermore, I am aware that Jefferson
County encourages the use of forestry on lands so designated. In doing so, the County has
set the goals to: (1) Sustain and enhance forest resource operations of long-term commercial
significance by protecting them from incompatible development; and (2) Alert owners and
potential purchasers of adjacent lands as to the nature of land uses and activities to be
expected on lands so designated.
I therefore acknowledge that in developing a use on my parcel, which may not be a
commercial forest activity, I am aware that any adjacent designated forest resource lands are
encouraged to be used for commercial forest operations and practices as long as the lands
remain designated by Jefferson County as forest resource lands, and as long as the
operations and practices conform to the policies set forth by the Forest Practices Board and
Title 222 WAC. For the purpose of this acknowledgment, I understand that commercial
forest operations include the right to grow, manage, and harvest timber.
Ali i. , 023
•
DATED this 3 day of F H , 19 q S
).-y1 • S
• ..-ri Owner 'r,nature
Property Owner Signature
Property Owner Signature
R
Property Owner Signature
Property Owner Signature
Property Owner Signature
Property Owner Signature
Property Owner Signature
Additional property owner's signatures on page
Acknowledgment:
• ;10 • f
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Notary public in and for the State of Washington, e NOTARY '
residing in /V D A pL/9/t 1 D Washington. •kPUBLIC o
My commission expires: /0 — /S— 9S '.O• '�
15-9$
\\st3WAS e.
THIS SPACE FOR NOTARY STAMP
Signatures are to be notarized, and completed form filed for record with the Jefferson County
Auditor.
-VOL 593 •HWf 924
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