HomeMy WebLinkAboutLog Item 2JEFFERSON COUNTY- FEB -8 2002 i i,
DEPARTMENT OF COMMUNITY DEVELOPMENT
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621 Sheddan Street. Po~ Townsend--W~shihgt°'~'98368:''~'''::
360,379-4450.800,831-2678. 360,379-4451 Fax
Boundary Line Adjustment (BLA) Supplemental Application
JMLA#
PROJECT/APPLICANT NAME:
Submittal Requirements
[] A completed Master Land Use Application. Representative authorization is required if application is not signed by owner.
[] Boundary Line Adjustment application fee, as set forth in the Jefferson County Fee Ordinance, as amended.
Three copies of a clean and legible drawing suitable for recording showing the following:
a. The proposed lines for all affected lots, tracts, or parcels, indicated by bold solid lines;
b. The existing lot, tract or parcel lines proposed to be changed, indicated by light broken lines;
c. The intended future use of the adjusted lots, tracts or parcels;
d. The location and dimensions of all structures/improvements existing upon the affected lots, tracts or parcels and the
distance between each such structure/improvement and the proposed boundary lines, with structures proposed to be
removed from the site depicted with broken lines, and structures to remain on the site depicted with solid lines;
e. The original legal description of the entire property together with new separate legal descriptions for each lot, tract or
parcel, labeling them each as existing parcel A, existing parcel B, revised parcel A, revised parcel B, etc.;
A north arrow indication and scale;
All assessor's tax parcel numbers for the affected lots, tracts or parcels;
The location of the property as to quarter/quarter section;
The location and dimensions of any easements within or adjacent to any affected lots, tracts or parcels;
The location, right-of-way widths, pavement widths and names of all existing or platted streets or roads, whether public or
private, and other public ways within or adjacent to the affected lots, tracts or parcels;
The areas and dimensions of each lot, tract or parcel, following the proposed adjustment;
The existing, and if applicable, proposed future method of sewage disposal for each affected lot, tract or parcel, including
the location and dimensions of and proposed septic drainfleld;
The location of all existing and proposed water and storm drainage facilities; and
The approximate location and extent of any environmentally sensitive areas (ESAs), including any flood hazard areas lying
within the existing or revised parcel boundaries. (Maps are available for review from the Department of Community
Development.)
f.
g.
h.
i.
j.
m.
A copy of any Covenants, Conditions and Restrictions (CC&Rs), deed restrictions, or planned rural residential development
(PRRD) agreements pertaining to or affecting the property.
If an individual septic system is proposed (i.e., as opposed to connection to either a community drainfield or municipal sewer
system), written verification from the Jefferson County Department of Environmental Health that the lots, tracts, parcels or sites,
as each would exist after the boundary line adjustment, are adequate to accommodate an on-site sewage disposal system.
Please provide a brief descriPtion of the purpose of the proposed boundary line adjustment. The purpose of this Boundary
Line Adjustment is to reconfigure an existing 5.1+ acre parcel (APN 801 041 017) and an existing 34.4+ acre parcel
(APN 801 041 011)into a proposed 15.0+ acre parcel and a proposed 24.5+ acre parcel. See attached portions of Jefferson
County Assessor's Map for the NE% of Section 4, T 28 N, R 1 VV, W.M., for Existing Parcel configurations and Proposed
Parcel configurations.
Page 1
.
Please provide Existing Legal Descriptions of all affected lots, tracts or parcels. (Attach additional
Parcel A; Assessor's Tax Parcel No. 801 041 017
See Section 1, on Page 1 of 5, of exclosed Boundary Line Adjustment & Statement of'Intent document.
Parcel B: Assessor's Tax Parcel No. 801 041 011
See Section 2, on Pages 1 & 2 of 5, of enclosed Boundary Line Adjustment & Statement of Intent document.
Parcel C:
Parcel D:
3. Please provide Proposed Legal Descriptions of all affected lots, tracts or parcels. (Attach additional sheets if necessary.)
Parcel A~ See Section 4, on Page 3 of 5, of enclosed Boundary Line Adjustment & Statement of Intent document.
Parcel B: See Section 5, on Pages 3 & 4 of 5, of enclosed Boundary Line Adjustment & Statement of Intent document.
Parcel C:
Parcel D:
.
a.
All owners of the subject properties must sign the application below to signify agreement to the proposed boundary line
adjustment.
The applicants hereby certify that all of the above statements are true and the plot plan provides an accurate
representation of the proposed boundary line adjustment, and the applicants hereby acknowledge that any permit
issued on this application may be revoked if any such statement is found to be false.
~~ A ~~'~~ Date:
' Date:
Date:
Date:
LOG ITENi
Page
Page 2
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