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Home My WebLink AboutLog Item 1JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street Port Townsend Washington 98368 360/379-4450 800/831-2678 360/379-4451 Fax Master Land Use Permit Application Form PROPERTY INFORMATION Tax Parcel Numbers: 801 041 011 and 801 041 017 Portions of the NE¼ of Section 4, T28N, RlW, W.M. Subdivision Name: N/A Lot Number: N/A Property Size: 39.5_+ acres Existing Use of Property: Agricultural Site Address and/or DirectiS"fls to Property: On the West side of West Valley Road approximately 1320 feet South of its intersection with Egg & I Road. APPLICANT INFORMATION Name of Applicant: James R. McKay Telephone: (360) 732-4358 Address: 4772 West Valley Road City: Chimacum State: WA Zip Code: 98325 Name of Authorized Agent: Tillman Engineering Telephone: (360) 379-9661 Address: 141 Oak Bay Road / P.O. Box 1375 City: Port Hadlock State: WA Zip Code: 98339 DESCRIPTION OF PROPOSED USE OR ACTIVITY (include separate sheets as necessary) To reconfigure an existing 5.1+ acre parcel and an existing 34.4+ acre parcel, by Boundary Line Adjustment, into a 15.0+ acre parcel and a 24.5+ acre parcel. PERMITS REQUESTED FROM JEFFERSON COUNTY Please check with Permit Center personnel before completing this section and refer to the specific sections of the UDC referenced below for more information and further requirements. An asterisk (*) indicates that a supplemental application or questionnaire is required. Type I Permits _ Septic Permit/Evaluation of Existing System (EES) _ Building/Demolition Permit Allowed "Yes" Use Consistency Analysis Home Business Stormwater Management * Road Access* UDC X Boundary Line Adjustment* UDC Minor PRRD Amendments UDC _ Sign Permit* UDC _ Site Plan Approval Advance Determination (SPAAD) UDC Shoreline Master Program Exemption/Permit Revisions UDC _ Temporary Use (based on use may be Type II or Type III)* UDC Refer to: UDC Section 6.4.1 and Chapter 8.15 JCC UDC Section 3.2.1 and Table 3-1 UDC Section 3.2.1 and Table 3-1 Table 3-1 and UDC Section 4.20 UDC Section 6.7 Section 6.8 Section 7.2 Section 3.6.13.15 Section 6.15 Section 8.7 Section 5 Sections 4.38 and 4.39 Type II Permits _ Discretionary "D" or Unnamed Use Classification _ Cottage Industry LOG ITEM I , of_ Refer to: UDC Sections 3.2.1, 3.2.2 and Table 3-1 UDC Section 7.3 and Table 3-1 _ Short Plat, Preliminary and Final* _ Binding Site Plan* Conditional (Administrative)"C(a)" _ Conditional (Discretionary) "C(d)" _ Variance, Minor* Wireless Telecommunication Shoreline Substantial Development (Primary Use) Forest Practices Act/Release of Six-Year Moratorium for Single-Family Residence _ Temporary Use* UDC Section 7.3 , UDC Section 7.5 FEB - 8 2002 Use UDC Table 3-1 and Section 8.8 Use UDC Table 3-1 and Section UDC Section 8.9 Ordinance 06-0712-99 (UDCAppendix:C) UDC Section 5 UDC Section 4.16.5(c) UDC Sections 4.38 and 4.39 Type III Permits Conditional "C" Use _ Long Plat, Preliminary* _ Planned Rural Residential Development Preliminary Approval (PRRD) and Major Amendments* Plat Vacation/Alteration _ Variance, Major* Reasonable Economic Use Variance* Wireless Telecommunication Ordinance 06-0712-99 _ Shoreline Management Substantial Development, Secondary Use* Shoreline Management Conditional Use* Shoreline Management Variance* UDC Section 8.8 UDC Section 7.4 UDC Section 3.6.13 (must be in conjunction with an underlying land division application) UDC Section 7.1.3(d) UDC Section 8.9 UDC Section 3.6.4(h) UDC Appendix C UDC Section 5 UDC Section 5 UDC Section 5 Type IV Permits _ Long Plat, Final _ PRRD, Final UDC Section 7.4 UDC Section 3.6.13 Type V Permits _ Special Use (Essential Public Facilities) _ Jefferson County Comprehensive Plan/UDC/Land Use District Map Amendment* _ Jefferson County Shoreline Master Program Amendment* UDC Section 3.3.5 UDC Section 9 UDC Section 5 Other Local, State or Federal Permits Please identify any other local, state or federal permits required for this proposal, if known: ACKNOWLEDGEMENTS By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. ! also certify that this application is being made with the full knowledge and consent of all owners of the affected property. 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 its employees, representatives or agents for the sole purpose of application review and any required later inspections. This right of entry shall expire when the County (through the Administrator or the Administrator's representatives) concludes the application has complied with all applicable laws and regulations. Access and right of entry to the applicant's property shall be requested and shall occur only during regular business hours. I hereby designate application for permit(s). to act as my agent in matters related to this (APPLICANT SIGNATURE) LOG ITENt P ge Z (DATE) FEB -8 2002 The action or actions Applicant will undertake as a result of the issuance of this permit m~y negatively impact upon ~ one or more threatened or endangered species and could lead to a potential "take" of an endaqg.ered species as .......... ~ those terms are defined in the federal law known as the "Endangered Species Act" or"ESA." JeffersonlC0unty- ~- ~ ~ makes no assurances to the applicant that the actions that will be undertaken because this Permit hasbee~-.iSsued:.!-i.: t: ~ .... will not violate the ESA. Any individual, group or agency can file a lawsuit on behalf of an endangered species regarding your action(s) even if you are in compliance with the Jefferson County development code. The Applicant acknowledges that he, she or it holds individual and non-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. (APPLIC/~ O~R AUTHORE. ED'REPRESENT,~;I~/E $1GNATUEE) (DATE)