HomeMy WebLinkAboutBLD1996-00171 -rieffc•rson County Permit Center , Date
621 Sheridan Street Fee '
Port Townsend WA 98368 Rec #
CRITICAL AREAS QUESTIONNAIRE Ck #
Case #
Applicant Name C+4 r z.E :d A, '.,.
wilding 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:
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 YES 1( 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 '4 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)
Li LT'
r r / / / / .'
r r / / / /
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ri ; / / /r /
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- (Questionnaire Continues on Back)
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 YES NO
sand?
If YES, please describe:
8. Does the site contain ground water seepage or springs near the YES K 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 1l 4- / 6
-� �� �-x. ,
FOR OFFICE USE ONLY
❑ Wetlands ❑ Seismic
CRITICAL AREAS ON OR ❑ Aquifer Recharge Area (zone ) ❑ Fish & Wildlife Area 1
IMMEDIATELY ADJACENT TO SITE: ❑ Frequently Flooded Area ❑ Fish & Wildlife Area 2
❑ Erosion
❑ Landslide
Zone:
Parcel Size: Status:
Comprehensive Plan Land Use Designation: Reviewed by:
Community Plan: Date:
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