HomeMy WebLinkAboutBLD1994-005270
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JEFFERSON COUNTY PERMIT CENTER
621 Sheridan Street
• Port Townsend, 379-4450
Critical Areas Questionnaire
1. Is there any standing or running water on the surface of the
property or on any nearby property at any time during the year? YES `' NO
If YES, please describe:
2. Has any portion of the property or any nearby property ever been YES K NO
identified as a wetland or swamp?
If YES, please describe:
3. Are any willows, skunk cabbage, alders, or cottonwoods present on
your property or adjacent properties? YES NO
If YES, please describe:
4. Are there any indications on any portion of the property or on any
nearby property of rockslides, earthflows, mudflows, or landslides? YES NO
If YES, please describe:
•
5. Please indicate which line best represents the steepest slope found
on your property. (Check appropriate box)
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6. Does the site have steep slopes with little to no vegetation? YES x NO
If YES, please describe:
•
7. Does the site contain high percentages of silt and/or very fine sand? YES '< NO
If YES, please describe:
8. Does the site contain ground water seepage or springs near the YES NO
surface of the ground? — 7_
If YES, please describe:
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.
,4- ,), _...- Date �-
Signature
•
JEFFERSON COUNTY PERMIT CENTER
621 Sheridan Street
Port Townsend, 379-4450
Critical Areas Questionnaire
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:
2. Has any portion of the property or any nearby property ever been YES K NO
identified as a wetland or swamp?
If YES, please describe:
3. Are any willows, skunk cabbage, alders, or cottonwoods present on YES NO
your property or adjacent properties?
If YES, please describe:
4. Are there any indications on any portion of the property or on any YES NO _
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)
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6. Does the site have steep slopes with little to no vegetation? YES NO
If YES, please describe:
7. Does the site contain high percentages of silt and/or very fine sand? YES NO
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:
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