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HomeMy WebLinkAboutSEP1973-00167PROPERTY OWNER MAILING ADDRESS PHONE SYSTEM DESIGNER LEGAL DESCRIPTION: Subdivision Name SITE LOCATION SOURCE OF SEWAGE: SEPTIC PERMIT APPLICATION WNW Area ..: 1scq 19 Section �_ Township Range I K) PARCEL # q51206 7®' CQQCA"'' Division Block 7_ Lot(s) its - 13 1 � j&,r &W P�� ,D 1 D� , �, Zip Code 9433q Residential Residential ADU Commercial Community TYPE OF WORK: New Redesign Upgrade Repair Partial (tank) (drainfield) Expansion Designate Reserve Area A_ Conventional A Alternative Drainfield Length I ft. Number of Gallons/day a2 b Site Size 1,5'0 9I Ig . Water Source: private public X Trench/Bed Depth Zir, in. Trench Width a- ft. Number of Lines I Septic Tank size /Oleg gal. Pump Chamber size gal. Soil type .2 ?5(ATTACH SOIL EVAL.) I"t6M` rate an e4st vw W - Previous eval: yes / no SEP - 3J�Application Rate ,� gal./sq.ft./day TYPE OF SYSTEM �� ISi'rna CVL , By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson County against all liabilities, judgments. court costs, reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and it's employees, representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours. Appeal - A person aggrieved of a decision of the Health Officer may appeal. Appeals shall be submitted to the Health Division in writing within fifteen days after receiving written notice of the decision - DISCLAIMER -This application is for an on-site sewage system that meets the state and county standards in effect on the date of application. This application for an onsite sewage system DOES NOT assure you of any other County approvals. For example, it DOES NOT GUARANTEE that you will later obtain permission to build a permanent residence or other structure on this parcel. Any future application will be separately judged by the rules and laws in effect at that time. gL41"=48--X7_03 Owner Signature Date FOR OFFICE GSE ONLY PARTIAL APPROVED PRESslrEST ASBUILT FINAL PUD Free District Planing District School District Zone Date ? a_7 LOb Fee f W Rec # SD �SS Check # Case # SEP13 1 H-.\env_health\linda\GD\FORBdS\SEPTIC PER)= APPLICATION.DOC 7101 INDICATE the following,Wormation. Draw entire pard to 09fe: gicate scale of plot plan. One inch equals ❑ 1. North arrd'A ❑ 2. All prop," bouroOleswd di: I ❑ 3. Namcs'of �N W0141 ?V� ❑ 4. Drivew�.R►f esu.. a s ❑ 5. Major features such as ravines, seasonal creeks, bodies of water, etc. ❑ 6. Septic tank, drainfield and reserve area location, existing or proposed, and distance to closest structure. ❑ 7. Sewer lines ❑ 8. Wells and/or water lines ❑ 9. Neighboring welts within 150 feet ❑ 10. Paved surfaces (patios) ❑ 11. Structures, existing and/or proposed ❑ 12. Setbacks (distances to property boundaries, structures, banks, and shorelines) ❑ 13. Easements for access or utilities ❑ 14. Arrows showing direction of slope— assume an elevation of 100 feet at one lot comer and indicate the other lot comer elevations in relation to it FOR APPLICATIONS ADJOINING SHORELINES, INDICATE: ❑ 15. Ordinary high water mark ❑ 16. Top of bank, if over 10 feet high ❑ 17. Slope of bank in degrees ;ATION MAP MPLE PLOT PLAN stances and setbacks irked in feet. N road Ntss's Corrt&r -Pk. BOUNDARIES Activity Report FILENAME/NUMBER SEP'I3 `' I1.o-1. PARCEL# 9 NAME/ADDRESS i A nCj SITE ADDRESS 1 S b C1 -Ac -r- SA • Poc- R_o —WI% --3(q. \ . Health Department Staff GQ A,- Date q - 11-63, e cyW-4e� ave -I!-,o C� a Co.T i ave *V\-� I Akl -tom c� ��c�\.� �� -'�� �"c,r•,k, , � r . � oh.+n�rs-n �� 1�0`` -fir% (i tik �'� � �o � n� U RX cmc +VXA 0� AV�9- � tWIQ -" 40LV� P�; ks ��r -t- -� \, c,� ivsL *P v- +- I .b rner�-e r IPDAI-A a� aA.QLOA 1 a I cedes-. s+ Actions. Linda Atkins To: Stacie Hoskins Subject: Richard Johnson BLD03-539 Stacie, Just spoke to Lowell Mathew and told him we need new plan showing the drywell away from the septic tank (could be toward Cedar). and need the real septic tank location. he explained he had just been there and plans to excavate to find the actual septic tank location and will submit a new plan. Also told him a Restrictive Covenant would be required to combine the lots, please be sure to include 10 -13, not just 10-12. He said it could be a week or 10 days before he would get it to us. thanks linda atkins 1 SOIL EVALUATION PROPERTY OWNER j2rhne®,,, SYSTEM DESIGNER `� e, E VILEW LEGAL DESCRIPTION: Section Township Range Parcel # q6A rod slB,!�, Subdivision Name 6u, 7D_ Division Block ' Lot(s) IA _ 13 Date Logged: 9,-,2-3-03 Logged By: 7Be,"-+ EYIGs' ,0 Include sod textural characteristics and the depths at which significant changes occur. Be sure to include depth where mottling or impermeable layers occur. SOIL LOG #1 T. 26, S Q_to_j in. C> ew,-Gs- -pti 13 tonin. 7 n:6A; - jP - SAA. to in. to in. Anticipated water tables47 in. Roots to 40 inches Health Dept. Comments , SOIL LOG #3 to in. to int. to in. to in. Anticipated water table in. Roots to inches Health Dept. Comments SOIL LOG #5 to in. to in. to in. to in. Anticipated water table in. Roots to inches Health Dept. Comments H:UNFOHLMSOIL.FRM 1 i00 SOIL LOG #2 T -Xs. _Q_to i-,, in. L'6L -eg& .vtA. P3 to_kf__in.7,m -e n d.sj. to in. to in. Anticipated water table,. -U in. Roots to —( inches Health Dep .Comment C l �- S t� SOIL LOG #4 v to in. to in. to in. to in. Anticipated water tabl in. Roots to inches J� Health Dept. Comments SOIL LOG #6 to in. to in. to in. to in. Anticipated water table in. Roots to inches Health Dept. Comments 4& 02P 1 N F;,"I �e, 40 S 03 E. Caroline Port Angeles SY-73 --167 OLYMPIC HEALTH DISTRICT Permit No.� � 1rt 7 SEWAGE DISPOSAL PERMIT APPLICATION Submit in Duplicate Builder Court House ��� Port Townsend Dat CZ A OWNER • `� , �, VNS -e ADDRESS i, �: ��,e �� --- PHONE �', S C S70 DIRECTIONS FOR LOCATING SITE���� APPLICATION IS HEREBY MADE T0: INSTALL NM4 SYSTEM (,-�PAIR EXISTING SYSTEM DRAINFIELD LENGTH U�� 1,1IDTH �r DEPTH r. #LINES_SEPTIC TANK SIZE DRAB'! A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE -� A117 ------^ —• +.� .•wr r�.wa vw�ail 1 i1C11Y' LIVVliii VL\ V11 IJii.LJ'- PERMIT UNLESS PRIOR APPROVAL OBTAINEDFROMTHE HEALTH DEPARTMENT. DATE OF INSTALLATION- �% C''�S��MNATURE OF APPLICANTk APPROVE) ✓ DATE 4 A//7_3, INSPECTED BY SANITARIAN'S COWIWTS : I CERTIFY THAT THIS S t:r INST�.LLED IN TIM MANNER APPROVED BY THE HEALTH DEAPRTMFNT �` r DATE DATE A 3 YPE OF BUI ING NO: OF BEDROOMS BASvEPIENTI SITE SIZA NAME OF INSTALLER DRAINFIELD LENGTH U�� 1,1IDTH �r DEPTH r. #LINES_SEPTIC TANK SIZE DRAB'! A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE -� A117 ------^ —• +.� .•wr r�.wa vw�ail 1 i1C11Y' LIVVliii VL\ V11 IJii.LJ'- PERMIT UNLESS PRIOR APPROVAL OBTAINEDFROMTHE HEALTH DEPARTMENT. DATE OF INSTALLATION- �% C''�S��MNATURE OF APPLICANTk APPROVE) ✓ DATE 4 A//7_3, INSPECTED BY SANITARIAN'S COWIWTS : I CERTIFY THAT THIS S t:r INST�.LLED IN TIM MANNER APPROVED BY THE HEALTH DEAPRTMFNT �` r DATE DATE A 3 ENVIRONMENTALLY SENSITIVE AREAS REVIEW SEP73-00167 Owner: RICHARD E JOHNSON Site Address: 150 CEDAR AVE 150 CEDAR AVE PORT HADLOCK WA 98339-9511 PORT HADLOCK WA, 98339 Parcel Number. 952800705 ST -R: 2-29N-01 W Legal Description GARFIELD'S ADDITION BLK 7 LOTS 10 THRU 13 Total Acreage: 0 Flood Map (FIRM) Panel No:5300690170B Fire District: 1 Flood District: Planning Area: 4 School District 49 WATER SUPPLY UTILITY: Service Area PUD: [ ] Assesor's Map [ ] Forest Lands: Adjoining Forest Lands: [ ] ESA'S Wetlands: Aquifer Recharge Area: Flood: Erosion: c Landslide: Seismic: Fish & Wildlife: c� Stream Type: Shoreline Designation: SIPZ: Flood Certificate: Violations: Require Declaration of Restrictive Covenant to meet minimum land area Recorded Date of Subdivision: <5yrs=Plat Conditions on plat or Old Ordinance PARCEL TAGS: No parcel tags found for this parcel. Associated CASES status issued finaled description SEP73-00167 F 6/4/1973 6/6/1973 1•\F MIT FCA Pdaviaw mt Atinimt 97 gnm JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT k 621 Sheridan Street Port Townsend, WA 98368 RICHARD E JOHNSON Al Scalf, Director 150 CEDAR AVE PORT HADLOCK WA 98339-9511 RE: SITE ADDRESS: 150 CEDAR AVE MLA #: MLA03-00495 CASE #: BLD03-00539 Dear RICHARD E JOHNSON: The Department of Community Development is in the process of reviewing your application. The following Information is needed to continue review of your project 1. Your proposal is to develop across separate lots: Parcel 952 800 705 Section 2 Township 29 N Range 01 W Subdivision Garrield's Addition Block 7 Lots 10 Thru 13 Setback requirements will not allow for, the development (septic and residence) to span over lot lines. Please record a Declaration of Restrictive Covenant with the Jefferson County Auditors Office. The procedure is as follows: a. Complete and sign the enclosed covenant in front of a notary. b. Bring the completed copy to the Department of Community Development for UDC Administrator signature. c. Once the Administrator has signed the Declaration, you will need to take it to the Auditor's office for recording. The fee for recording is $21.00 payable to Jefferson County Auditor ($19.00 for the first page, $1.00 per additional page). 2. Please submit a revised site plan addressing Linda Atkins' of Environmental Health concerns. She commented the drywell cannot be located in the area proposed and the septic tank is not In the location identified. Call me at (360) 379-4463 with any questions. Please submit the above Information to the Department of Community Development by December 29,200& Pursuant to Unified Development Code Section 82.3.c and f., If the applicant refuses to submit the additional information or does not request additional time to submit the _ required information within the ninety (90) calendar day period, the application will be oonsidered abandoned and therefore withdrawn and the applicant shall forfeit the application fee. The Department of Community Development shall not be responsible for notifying the applicant of an . impending expiration. SincerIy, epartment of Comma Development Stuff c: File LOWELL G MATTHEW Building Permits/ Inspections Development Review Division Long Range Planning (360) 379-4450 FAX: (360) 379-4451 Jr Jefferson County Department of Community Development Development Review Division, 621 Sheridan Avenue Port Townsend, WA 98368 DECLARATION OF RESTRICTIVE COVENANT Grantors: Grantee: Jefferson County Department of Community Development Jefferson County Health & Human Services THIS DECLARATION is made and entered this day of , 2 , by , hereinafter referred to as "Owner(s), the legal and equitable owner(s) of the real property described herein. A. RECITALS 1. Legal Description: This Restrictive Covenant shall affect and restrict the real property ("the property") legally described as follows: Parcel Number Section Subdivision Block Township Range Lot 2. Building Permit Application. The Owner(s) have applied or will apply for a building permit through the Jefferson County Department of Community Development ("the County") and/or an on-site sewage permit through the Jefferson County Health & Human Services ("Health Department') to make certain improvements upon the above-descn'bed property. 3. Purpose. For purposes of complying with the County's building and land use codes and ordinances, as well as the Health District's minimum land area for issuance of an .on-site sewage permit per WAC 246- 272, the Owner(s) desire to treat all of the above-described property as one building tract, and in particular, desires to do so for the purpose of constructing a utilizing an individual on-site sewage disposal system, as required by county code and/or state health regulations. Page 1 of 3 0 4. Assurance to County. The Owner(s) desire to assure the County that the property described above shall be and remain as one building tract for purposes of improvements to be constructed upon the property; NOW, THEREFORE, in consideration of the benefits derived by this Restrictive Covenant, the Owner(s) declare, covenant and agree as follows: B. COVENANT 1. Specific Restriction and Covenant. The property described above, shall constitute a single building site, and no lot or lots or any part thereof shall be transferred or conveyed in any manner unless and until the building(s), structure(s) or on-site sewage disposal provisions are made to conform to the then -existing zoning provisions on a reduced site. This restrictive covenant shall not be removed unless such an action is approved by the County and the Health Department. 2. Covenant Running with the Land. This restrictive covenant affects and restricts the described property and shall be construed as a covenant running with and touching and concerning the land and inuring to the benefit of the Owner(s), the public generally, and the County. 3. Binding upon Successors and Assigns. This restrictive covenant shall bind and restrict the land, the Owner(s), their heirs, grantees, successors and assigns. 4. Recording. Upon its execution, this Declaration shall be recorded with the Jefferson County Auditor. All contracts and deeds or other instruments of conveyance relating to the property or any part thereof shall contain reference to this covenant. 5. Enforcement. In addition to any other party having a legal right to enforce this covenant, the County shall have the right to enforce and compel compliance with this covenant, including all remedies available at law and equity. Tho County shall have the right in any such proceeding to recover its attorney fees and costs. 6. Compliance with Code Requirements. This Declaration does not amend or modify, nor is it intended to amend or modify any requirements of the County's ordinances or any other law or regulation dealing with or affecting the use of land or construction of improvements upon lands. 7. EstoppeL The Owners by this Declaration specifically estop themselves and all of their successors and assigns and all persons presently or hereafter having any interest in the property from asserting or contending in any manner that this restrictive covenant is not a full and adequate covenant running with the land and binding upon the property. & Severance. Invalidation of this covenant by judgment or court order shall not affect any of the other covenants which shall remain in full force and effect. Restrictive Covemwt Page 2 of 3 9. Warranty of Authority. The Owner(s) signing below warrant that they are the sole Owners in fee of the real property described above and are authorized to make this Declaration and so bind the property. 10. Governing Law. This RESTRICTIVE COVENANT shall be governed by the laws of the State of Washington. 11. Disclaimer. Since no survey was submitted as part of your Restrictive Covenant, the County accepts no liability for what facts a survey might have revealed A survey might have revealed that a structure or improvement believed to be on the grantor's property is, in fact, located wholly or partially upon someone else's property or upon property that is not the subject of this application. But, in the absence of a survey, the GRANTOR bears sole responsibility if such a problem arises. Dated this day of Owner STATE OF WASHINGTON) ) ss COUNTY OF JEFFERSON) On this day personally appeared before me, to me known to be the individual described in and who executed the within and foregoing instrument, and acknowledged that he signed the same as his free and voluntary act and deed, for the uses and purposes therein mentioned. Given under my hand and official seal this day of , 2 NOTARY PUBLIC in and for the State of Washington residing at My commission expires: Approved: UDC Administrator Date Reshi edn Covwmt Page 3 of 3 V OCT -3M JEFFERSON COUNTY OCD Jefferson County Department of Community Development Development Review Division, 621 Sheridan Avenue Port Townsend, WA 98368 U kTtc-c t� �- 475583 1111101111111111111111111pa":*1 of a Jefferson County, MA RICHARD E JOHNSON i(OY 2 f11e38A DECLARATION OF RESTRICTIVE COVENANT Grantee: Jefferson County Department of Community Development Jefferson County Health & Human Services THIS DECLARATJON is made and entered this y ofd 2 .0 2 by ` - hereinafter referred to as "Owner(s)," the legal and equitable owner(s) of the real property described herein. A. RECITALS 1. Legal Description: This Restrictive Covenant shall affect and restrict the real property ("the property') legally described as follows: Parcel Number - p'Q W Section d. Township _" Af Range aj w' Block_ •7 - Lot 2. Building Permit Application. The Owner(s) have applied or will apply for a building permit through the Jefferson County Department of Community Development ("the County") and/or an on-site sewage permit through the Jefferson County Health & Human Services ("Health Department") to make certain improvements upon the above-described property. 3. Purpose. For purposes of complying with the County's building and land use codes and ordinances, as well as the Health District's minimum land area for issuance of an .on-site sewage permit per -VAC 246- 272, the Owner(s) desire to treat all of the above-described property as one building tract, and in particular,. desires to do so for t)re purpose of constructing a Utilizing an regulations. ResdiW" Comms on-site sewage disposal system, as required by county code and/or state health Page 1 of 3 9(D0 �' J� 475983 illillilimilillilimililililliPam: 2 of 3 1910312M 11-304 Jefferson County, MA RICNMD E JOHNSON- COV 21.00 4. Assurance to County. The Owner(s) desire to assure the County that the property described above shall be and remain as one building tract for purposes of improvements to be constructed upon the property; NOW, THEREFORE, in consideration of the benefits derived by this Restrictive Covenant, the Owner(S) declare, covenant and agree as follows: @UDIU ; NN 1. Specific Restriction'and Covenant lice property described above, shall constitute a single building site, and no lot or lots or any part thereof shall be transferred or conveyed in any manner unless and until the buildmg(s), structures) or on site sewage disposal provisions are made to conform to the thewexistmg zoning provisions on a reduced site. This restrictive covenant shall not be removed unless such an action is approved by the County and the Health Department. Z. Covenant Running with the Land. This restrictive covenant affects and restricts the described Property and shall be construed as a covenant running with and touching and concerning the land and inuring to the benefit of the Owner(sh the public generally, and the County. 3. Binding upon Successors and Assigns. This restrictive covenant shall bind and restrict the land, the Owner(s), their heirs, grantees, successors and assigns. 4. Recording. Upon its execution, this Declaration shall be recorded with the Jefferson County Auditor. All contracts and deeds or other instruments of conveyance relating to the property. or any part thereof shall contain reference to this covenant. 5. Enforcement. In addition to any other party having a legal right to enforce this covenant, the County shall have the right to enforce and compel compliance with this covenant, including all remedies available at law and equity. The County shall have the right in any such proceeding to recover its attorney fees and costs. 6. Compliance with Code Requirements. This Declaration does not amend or modify, not is it intended to amend or modify any requirements of the County's ordinances or any other law or regulation dealing with or affecting the use of land or construction of improvements upon lands. 7. Estoppel. The Owners by this Declaration specifically estop themselves and all of their successors and assigns and all persons presently or hereafter having any interest in the property from asserting or contending in any manner that this restrictive covenant is not a full and adequate covenant running with the land and binding upon the property. & Severance. Invalidation of this covenant by judgment or court order shall not affect any of the other covenants which shall remain in full force and effect. Resdrkti" comimt Page 2 of 3 IIIII g��312M3 11:38A w73883 21.00 9. Warranty of Authority. The Owner(s) signing below warrant that they are the sole Owners in fee of the real property described above and are authorized to make this Declaration and so bind the property. 10. Governing Law. This RESTRICTIVE COVENANT shall be governed by the laws of the State of Washington. 11. Disclaimer. Since no survey was submitted as part of your Restrictive Covenant, the County accepts no liability for what facts a survey might have revealed A survey might have revealed that a structure or improvement believed to be on the grantor's property is, in fact, located wholly or partially upon someone else's property or upon property that is not the subject of this application. But, in the absence of a survey, the GRANTOR bears sole responsibility if such a problem arises. Dated this 'J day of ©c�y�a r , 200 -3. - owner 003.Owner STATE OF WASHINGTON) )ss COUNTY OF JF.F 9MSON ) On this day personally appeared before me, R i c\nx.r tome known to be the individual described in and who executed the within and foregoing instrument, and acknowledged that he signed the same as his free and voluntary act and deed, for the uses and purposes therein mentioned. Given under my hand and official seal this 3day of ��L�� V •e r , 2 44a. O� �SSIOAi q.Q'P� !� NOTARY PUBLIC in and for the State of Washington residing - 0 14 y Q' .C). PLIBM tj!L0111 ilt Ile at My commission expires: Ct , q0 /�3 h3 Peshica a Covemut Page 3 of 3 A4 'S C' P 1��- V I- C' W • " BUILDING PERMIT APPLICATION MLA03-00496 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00540 Received Date: 8/28/2003 SITE ADDRESS: 150 CEDAR AVE PORT HADLOCK, 98339 OWNER: RICHARD E JOHNSON PHONE: (360) 385-5418 150 CEDAR AVE PORT HADLOCK WA 98339-9511 SUBDIVISION: GARFIELD'S ADDITION Block: Lot PARCEL NUMBER: 952800705 Section: 2 Township: 29 N Range: 01 W CONTRACTOR: REPRESENTATIVE: PRESTIGE PROPERTIES 11524 RHODY DRIVE PORT HADLOCK WA 98339 PHONE: (360)385-9033 Contractor's License PRESTP1066CM Expires 11/13/2004 LOWELL G MATTHEW 261533 HWY 101 SEQUIM WA 98382 PROJECT DESCRIPTIOP GARAGE & STORAGE PHONE: (360) 681-3094 TYPE OF WORK GAR SQUARE FOOTAGE: NO AREA TYPE OF IMP NEW Seismic Streams VALUATION 21,355.00 MAIN: 180 Landslide CODE EDITION: 1997 ADD'L: HEAT TYPE: OCCUPANCY: 58457 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: 726 SETBACK: DECK BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: Exist Prop: Prop: Total: Total: Routing Date: PARCEL TAGS: YES NO STORMWATER: YES NO AREA Wetland Erosion Seismic Streams Flood Way Floodplain F&W Landslide Shoreline Aquifer Forest: Commercial Rural Type Amount Paid Bv: Date: Receipt: Approved/Date n� Permit $349.25 MJA 08/28/03 58457 Plan Check $162.01 MJA 08/28/03 58457 ( State Building Code $4.50 MJA 08/28/03 58457 P6, rzu�'4 l'o_ w-cs, Total: $515.76 _`'PA Vj MLA03-00495 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00539 Received Date: 8/28/2003 SITE ADDRESS: 150 CEDAR AVE PORT HADLOCK, 98339 APPLICANT. RICHARD E JOHNSON PHONE: (360) 385-5418 150 CEDAR AVE PORT HADLOCK WA 98339-9511 SUBDIVISION: GARFIELD'S ADDITION Block: Lot PARCEL NUMBER: 952800705 Section: 2 Township: 29 N Range: 01 W CONTRACTOR/ PRESTIGE PROPERTIES DEALER: 11524 RHODY DRIVE PORT HADLOCK WA 98339 PHONE: (360)385-9033 Contractor's License PRESTP1066CM Expires 11/13/2004 REPRESENTATIVE: LOWELL G MATTHEW 261533 HWY 101 SEQUIM WA 98382 PROJECT DESCRIPTION: MANUFACTURED HOME REPLACEMENT TYPE OF WORK MOB TYPE OF IMP NEW VALUATION 52,000.00 LABOR & INDUSTRIES APPROVAL? SEWAGE DISPOSAL: OSS WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist Exist Prop: 2 Prop: 2 Total: 2 Total: 2 MANUFACTURED HOME: MAKE: GOLDENWEST YEAR: 2003 SIZE: 27 X 48 Routing Date: 9 1 �Oe PHONE: (360) 681-3094 SHORELINE: SETBACK BANK HEIGHT: PARCEL TAGS: YES NO STORMWATER: YES NO AREA Plat Conditions Wetland Erosion Seismic Streams Flood Way Floodplain F&W Landslide Shoreline Aquifer Type Amount Paid BY: Date: Receipt: Permit $151.00 MJA 08/28/03 58457 Potable Water Application $51.00 MJA 08/28/03 58457 Total: $202.00 Approved/Date o- J� rt tG�ilf2t �C��tirso �GJ e -c AUG 28 2003 JEFFECOL1N `rte e?,F 14-A-PL-oae S'�i I • �_ rDEPT.0FCn!,pAm-oTYDEVE PMENT-t. ,�EL goo 7aff= . . . . . . . . . . . . . . ��lp z Pz IE � e �A-RPaL1" Sp` 91/ ROOM � DEN Z� I '►°�'� ' ' BATH 14 • MASTER BEDROOM Nk ` /huvHmtRO1 BEDROOM 12 _ �l)1(00 �zo o.. .......... 3 h 5 F of ,s�' • ' s V. ►� NX 0711 eP =Q-clQ Q lir , �ION "OOMOM (� AooBovaMRIF Ito 7R v - "�. Ea�V rwou L ROOM maw % i oa� ° 1V3H 1V1N3WNOHIAN3 Am= Nosa3333r ,os ' _�10la2Q z/ f Ilk y o II � - * iN3wdal3nld3G O/ 8 z ens .a c� NQS' jQ I? f>. fi' . 00, 1. . I oa� ° 1V3H 1V1N3WNOHIAN3 Am= Nosa3333r ,os ' _�10la2Q z/ f Ilk y o II � - * iN3wdal3nld3G O/ 8 z ens .a c� NQS' jQ I? f>. fi' . 00, Screen: 01 Parcel # 000952800705 • Taxpayer Cd * Title Owner Geo Cd 290102204211 GARFIELD'S ADDITION BLK 7 LOTS 10 THRU 13 JOHN 3160 JOHNSON, RICHARD E Mode: INQUIRY Auto Roll: OFF Nbad Cd 4211 T/P Chg Dt TIP Chg Usr Tax Code 0211 Status TX TAXABLE Land Use 1101 MH-REALW/LND Affidavit Vol/Page / C/U Code S/C Cd Screen: 01 Parcel # 000952800705 * Taxpayer Cd * Title Owner Geo Cd 290102204211 GARFIELD'S ADDITION BLK 7 LOTS 10 THRU 13 JOHN 3160 JOHNSON, RICHARD E Mode: INQUIRY Auto Roll: OFF Nbad Cd 4211 T/P Chg Dt T/P Chg Usr Tax Code 0211 Status TX TAXABLE Land Use 1101 MH-REALW/LND Affidavit Vol/Page / C/U Code S/C Cd