HomeMy WebLinkAboutBLD2000-00037 - Temp Exception j 0 !
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00037 Received Date: 1/14/2000
SITE ADDRESS: 220 -BEAVER VALLEY RD
PORT LUDLOW, 98365
APPLICANT: EARNEST L SLAGLE PHONE:
NANCY SLAGLE
2203 BEAVER VALLEY RD
PORT LUDLOW WA 98365
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821182003 Section: 18 Township: 28 N Range: 01 E
CONTRACTOR/ OWNER PHONE:
DEALER:
PROJECT DESCRIPTION MOBILE HOME INSTALLATION
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW
VALUATION MAKE: SETBACK:
YEAR: 1970
LABOR & INDUSTRIES APPROVAL?
SIZE: 24X44 BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: 2 Prop: 1 Seismic Streams
Total: 2 Total: 1 Flooding Landslide
F&W Plat Conditions
Shoreline Aquifer
Routing Date: (� . by Forest: Commercial Rural
1Proximity
Type Amount Paid By: Date: Receipt: Approved/Date
Permit [31°- $0700 MAM 01/14/00
Potable Water Application $0-t0 MAM 01/14/00 4-.J O '1
Total: $0 00---
1I13\0
prk 0
I:\F_BLD_App_Mob.rpt 10/29/99
0 •
JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST, PORT TOWNSEND WA 98368
MANUFACTURED HOME INSTALLATION PERMIT APPLICATION
❑ NEW BUILDING 0 REPLACEMENT
SIZE 7 ,K 4/
.71
YEAR / 9'70
MAKE S` enrual-#'
COST - 5—i 2010
BEDROOMS: BATHROOMS:
EXISTING _ _ EXISTING
PROPOSED PROPOSED
TOTAL
TOTAL /
TYPE OF SEWAGE DISPOSAL: WATER SUPPLY:
❑ SEWER ❑ COMMUNITY SYSTEM ❑ PRIVATE WELL Cl TWO PARY WELL
INDIVIDUAL SYSTEM A Conventional ❑ PUBLIC
PERMIT # SEP 0 Alternative Name of water system:
IF WATERFRONT PROPERTY,
DISTANCE TO BANK OR HIGH WATER LINE ft BANK HEIGHT ft
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.
SIGNATURE �� DATE j
NAME (PLEASE PRINT) ar `5 (� //r�� / ,t «
,...._
FOR OFFICE USE ONLY
BASE FEE '+ RECEIPT#
ADDITIONAL SECTIONS CASH/CK# �.,
SUBTOTAL 1 , , A ,� ' ; DATE r/ max'/
POTABLE WATER
911/ROAD APPROACH
,
TOTAL f Yam ,
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4
0 JEFFERSON COUNTY COMM�'Y DEVELOPMEJ'21 ;�' °f
- _tea- ERiD,4N �� P RT TOWNSEND ✓✓A 9£�B£
MANUFACTURED HOME INSTALLATION PERMIT APPLICATION
0 NEW BUILDING 0 REPLACEMENT
SIZE
YEAR , 7i
MAKE , -. SeX't 4-1-•4:k
COST r� /� 2� r--�'�'�
BEDROOMS: �-£�
BATHROOMS: V f
RECai T�, �Iltj
EXISTING
EXISTING /
PROPOSED R
PROPOSED 2 2009�
TOTAL J
TOTAL / JEF �. .,s{.. �,r„ .
TYPE OF SEWAGE DISPOSAL: 111 �rjuiv nil;
WATER SUPPLY:
0 SEWER 0 COMMUNITY SYSTEM
0 PRIVATE WELL 0 TWO PARY WELL
INDIVIDUAL SYSTEM Conventional
0 PUBLIC
PERMIT # SEP 0 Alternative
Name of water system:
IF WATERFRONT PROPERTY,
DISTANCE TO BANK OR HIGH WATER LINE
ft BANK HEIGHT ft
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.
SIGNATURE
DATE - S
NAME (PLEASE PRINT)
FOR OFFIC
E USE ONLY _
BASE FEE r
RECEIPT# }
ADDITIONAL SECTIONS
CASH/CK#
SUBTOTAL el,f " 0 DATE / ,.
POTABLE WATER d 0
911/ROAD APPROACH
H=II IOMEIPt,NCNTRTOFMSW(.01..EAP.10/99
•
• G& l/ )d -00e3
,�..._.: MANUFACTURED/ MOBILE HOME INSTALLATION
•
Jefferson County Department of Community Development
APPLICATION
621 Sheridan Street Port Townsend, WA 98368nt
PERMIT#: BLD00-00037
SITE ADDRESS. 2203 BEAVER VALLEY RD Received Date:
PORT LUDLOW, 98385 1/14/2000
APPLICANT: EARNEST L SLAGLE
NANCY SLAGLE PHONE: 73 ?
2203 BEAVER VALLEY RD ��
PORT LUDLOW WA 98365
SUBDIVISION:
PARCEL NUMBER: 821182003 Block:
Lot:
Section: 18 Township: 28 N
S
Range: 01 E
CONTRACTOR/
DEALER: OWNER
PHONE:
PROJECT DESCRIPTION MOBILE HOME INSTALLATION
TYPE OF WORK MOB
MANUFACTURED HOME:
VALUATION
TYPE OF IMP NEW
SHONE:
MAKE:
YEAR: SETBACK:
1970
LABOR & INDUSTRIES APPROVAL? SIZE:
24X44 BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: W YES�"' ��
BATHROOMS:
STORMATER: _ NO AREA
Wetland Erosion
Exist: Exist:
Prop: 2 Prop: 1 Seismic
Total: 2 Total: 1 Floodin Streams
F&W Landslide
Shoreline Plat Conditions
Routing Date: quifer
' FL( Forest: Commercial Rural
Proximity____L__
Type Amount Paid
Permit By: Date: Receipt: Approved/Date
Stlet
Potable Water Application $0.00 MAM 01/14/00
$0.00 MAM 01/14/00 S1. : '
Total: D
$0.00
r a'0\0'' k ,'--c:
`Q et
a
Mob.rpt
10/29/99
•
' Jerson County Department of Community Development December 1912000
621 Sheridan Street, Port Townsend, WA 98368
(360) 379-4450
FINDINGS AND CONDITIONS OF APPROVAL AS REQUIRED UNDER THE
JEFFERSON COUNTY INTERIM CRITICAL AREAS ORDINANCE
Applicant: EARNEST L SLAGLE
NANCY SLAGLE
2203 BEAVER VALLEY RD
PORT LUDLOW WA 98365
Critical Area Review Case Number: CAR00-00032
Project Description:
Parcel Number: 821182003 S-T-R: 18-28N-01 E
Site Address: 2203 BEAVER VALLEY RD
PORT LUDLOW WA, 98365
FINDINGS:
In accordance with the authority provided under subsection 4.101 and the requirements contained in Subsection
5.402 of the Jefferson County Interim Critical Areas Ordinance, the following are findings of fact relating to the
referenced application:
1.) The application was reviewed by Jefferson County Permit Center staff on 1/14/00 for the potential presence
of critical areas regulated under the provisions of the Ordinance, and the following critical areas were
confirmed as potentially present on the subject property: Wetlands, Seismic Hazard, Frequent Flooding,
Streams (Type III and V), Adjacent Commercial Forestland, and Landslide Hazard I (Low).
2.) Acting upon the above information, Jefferson County staff conducted a site inspection of the subject
property on 3/20/00 and confirmed the existence of the following critical areas and/or their associated
buffers on the property: Wetlands, Susceptible Aquifer Recharge Area, and Streams (Type III &V).
3.) The applicant submitted a Wetland Delineation Report in conjunction with their application. Olympic
Wetland Resources conducted the delineation and determined that the associated wetlands are Class I
Wetlands. Section 6 of the Jefferson County Interim Critical Areas Ordinance stipulates a setback (buffer)
of 75-feet from the associated wetland.
4.) FEMA mapping indicated a flood plain may be in close proximity to the proposed development. However, a
site investigation of the proposed property indicates that the proposed development is entirely upland of the
mapped floodplain. Section 4.202(10) of the Jefferson County Flood Damage Prevention Ordinance
identifies Duties and Responsibilities of the responsible official. Said duties include:
1. Make interpretations where necessary and where possible as to the exact location and boundaries of the
areas of flood hazard. For example, where there appears to be a conflict between a mapped boundary and
actual field conditions.
The topography of the property indicates that the proposed development is entirely upland of the floodplain,
therefore, a flood elevation certificate is not required.
5.) A disclosure statement has been completed regarding the adjacent forest lands setbacks for BLD00-00036
and BLD00-00037.
6.) Aquifer recharge areas in Jefferson County are characterized by porous geologic formations that allow
percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic
formations that contain sufficient saturated permeable material to yield significant quantities of water to
wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of
Jefferson County.
7.) Susceptible aquifer recharge 0s are those with geologic and hydrologic conditions that promote rapid
infiltration of recharge waters to groundwater aquifers. This includes any p n of Jefferson County with a
DRASTIC index of greater than or equal to 180 points as determined using U.S. Environmental
Protection Agency DRASTIC methodology: Drastic: A Standardized System for Evaluating Ground Water
Pollution Using Hydrogeologic Settings (EPA 600/23-87-035).
This waiver from the provisions of the Jefferson County Interim Critical Areas Ordinance is granted subject to the
following conditions. Any deviation from these conditions shall result in this waiver bein yoked and the
application becoming subject to further review.
CONDITIONS OF APPROVAL:i
•1.) A setback of 7 -feet,measure perpendicularly from the hewetland edge, sha I be/erm ntlymaintained
a buffer. No . ing, grading, clearing or other alteration of the wetland or its buffer isall ed.
as
2.) Prior to an during approved construction activities, the perimeter of the wetland buffer shall be marked with
a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the
construction area. The sign shall contain the following statement: "Wetland and Buffer- Do not Remove or
Alter Existing Native Vegetation."
3.) The applicant shall permanently separate the upland boundary of the wetland buffer from the remainder of
the subject property through installing and maintaining one of the following; logs, trees, a hedge row, or
other prominent physical marking. The separation method identified by the applicant shall be approved by
the Critical Area Administrator prior to planting or installation.
4.) All construction activities, including the storage and preparation of materials, shall not encroach upon the
designated wetland, or its associated buffer.
5.) A setback (buffer) of 25-feet, measured perpendicularly from the ordinary high water mark along the bank
of Ludlow Creek shall be permanently maintained as a fish and wildlife habitat area. In addition, a 15-foot
setback shall be maintained from the seasonal drainage ditch located adjacent to Highway 19.
6.) Fish and wildlife habitat area buffers shall remain naturally vegetated. Should buffer disturbance occur
during construction, replanting with native vegetation shall be required by the Critical Area Administrator.
No alteration shall be made to the fish and wildlife habitat area buffer without prior authorization by the
Critical Area Administrator.
7.) All construction activities, including the storage and preparation of materials, shall not encroach upon the
de ated fish and wildlife habitat area, its associated buffer, or any critically important plants and trees
id n fied on the subject property.
8.) T e. ::.sodde
velopment shall be located on the subject property exactly as identified on the Universal
Pl,zit,' . .r other Site Plan, approved by the County as part of the triggering permit application.
(r'
Ma' AIIIIPP 6'A i .1•12_ 77),
W12--"(t) en art, AICP Dat
Critical Areas Administrator 1_ 243/Zoo-a
I understand that the granting of the above waiver from the provisions of the Jefferson County Interim Critical
Areas Ordinance is made subject to my complying with the above listed conditions,and that any violation of said
conditions shall result in revocation of the permit or approval and further review of the project under the Critical
Areas Ordinance.
Please sign and return to the D artment of Community Development.
(.4.,(../(tAi-}' ' V
Applicant's Signa ure
ate
c: File
i:\F_CAR_Waiver_W_Conds.rpt 12/13/99
411 PLEASE MAIL TO:
]ESON COUNTY ASSESSOR
JACK WESTERMAN III JEFFERSON COUNTY COURTHOUSE
ASSESSOR PO BOX 1220, PORT TOWNSEND WA 98368
(360) 385-9105
MOBILE HOME INFORMATION FORM
OWNER'S NAME / MAILING ADDRESS: THIS IS NOTA TAX STATEMENT
NAME: ,,0 ,,e_ f (( The purpose of this questionnaire is to obtain information
regarding either the current location of a mobile home or the j
ADDRESS: 2 Zo j'i.(f V /6( previous ownership and location of a mobile home. This will
76��/ // � 3 / S-- help our office determine whether the mobile home is already
(,f�!'/ G{/ (O on the tax rolls in Jefferson County or if it has been moved to
/� this county from another area. Please see reverse side for
TELEPHONE NO: (Q 6 7� —�j v additional information.
S) MOBILE HOME DATA:
(A) MAKE (B) MODEL 97V
(C) YEAR I
(D) LENGTH (E) WIDTH 2 ( (F) SERIAL NUMBER
(G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX)`-n5 (H) PURCHASE DATE T 4,-,G /973
2) PREVIOUS OWNER / LOCATION OF MOBILE HOME:
r
(A) FROM WHOM DID YOU PURCHASE MOBILE , VI-e,1/14 f
ADDRESS
(B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES NO (IF NO, WHAT COUNTY? jib —/1( ) \) )
IF YES, WHAT WAS PREVIOUS ADDRESS OF MOBILE?
3) WHERE MOBILE HOME IS TO BE LOCATED:
(A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES NO'
(B) IF LOCATED IN A MOBILE HOME PARK:
NAME az ADDRESS OF PARK SPACE NO.
(C) IF NOT LOCATED IN A MOBILE HOME PARK:
NAME OF LAND OWNER: �� y� 4.1ajy\--eA "L
LOCATION (ADDRESS) h T Q te,444/1 /fr/r//L (1•91/,
_ V
REAL PROPERTY PARCEL NUMBER/ DESCRIPTION g 21 — / 8 Z -- 0�S
` Zg CIE 2_ rilVzft")
THANK YOU FOR YOUR HELP! ?:flyiLa-1
SIGNATURE
KELLI LARSON, Property Technician
THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION.
•
AGREEMENT
OF ANNUAL REVIEW AND REMOVAL OF TEMPORARY RESIDENCE
USED EXCLUSIVELY FOR FAMILY HARDSHIP
TI IS AGREEMENT is made this 2 dayof ) ���
/�/ )) � -� (� ,�399 by and between
/ ` Q/VC (Q /�� , hereinafter referred to as the "Owner", and
Jeffersonounty, a olitical subdivision of the State of Wash
ington, hereinafter referred to
as the "County", to wit
WHEREAS, 16Al l if is the owner of a certain tract
of land particularly describeias follows:
SIB / 2l+ It)]
S
Site Address: u y /�v a
�J
Assessor's Parcel ID#: , 2_1 —/g 2_ -- 7O3
And,
WHEREAS, the Owner has demonstrated family hardship which establishes a need for an
additional residence (manufactured home) to be placed on the above described property on
a temporary basis for the exclusive use of , and
WHEREAS, the placement of the second residence (manufactured home) is inconsistent
with the density standards of the Jefferson County Comprehensive Plan, and
WHEREAS, the legal water supply and sewage disposal requirements may only be achieved
if the second residence (manufactured home) is occupied as proposed, that is the temporary
occupancy by one person who is an immediate family member, and
WHEREAS, the Owner agrees to remove said residence (manufactured home) upon
termination of its occupancy by
NOW THEREFORE, in consideration of the premises and mutual promises and vovenants
hereafter set forth,the parties hereto agree as follows:
SPACETHIS
Signatures are to be notarized, and completed form filed for r co dw th tthe Je Offers n STAMPCounty
Auditor.
0
•
1. NATURE OF OCCUPANCY—The temporary residence shall be for the exdusive
occupancy of F,_f 7, p l <J. The Owner shall not authorze or cause to
authorize use by any other party.
2. REMOVAL OF STRUCTURE—The Owner will remove the temporary residence
within sixty(60) days from the date of termination of occupancy by
ri ---7i,,),ter_,;_z,W cj e-a*
3. ANNUAL INSPECTION AND FEE—The Owner will pay a$25.00 annual inspection
fee for an inspection of the residence and drainfield area by an authorized agent of the
County. The purpose of said inspection is to determine on an annual basis the status of
occupancy of the residence and the functioning of the sewage disposal system.
4. BREACH OF CONDTI'IONS—The Owner agrees that in the event of breach of the
above conditions,the County, at the Owner's expense, shall remove or cause to be
removed said residence (manufactured home) and terminate this agreement.
Owner: r ,/
Acknowledgement
Subscribed and sworn to before me this �� day of `���— �GV�C
......„
.NO TA 41.
,0 7 .---2,. ,,d,.,,,z_L..____
AU8' 2 Notary public in ardl for the
7.,'•• 8L1O /,2 1 State of Washington, residing in
C9 w�
� 19A S1* 1/4%N.®s , ,Washington.
JEFFERSON COUNTY BOARD OF COMMISSIONERS
Richard Wojt , Chair
A-. , 9 f ity 2
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RETURN ADDRESS ,
WASHINGTON FEDERAL' SAVINGS ' U .
191 W WASHINGTON, ST CC
SEQUOIM WA4898382 ��f1tun
(M B��
` TAT s"'"`.ow MANUFACTURED HOME � I'LL I.SL(RE('K OAT
l,CERSI�c APPLICATION MULE ELIMINATION
E)TRANSFER IN LOCATION
0
Anyone who knowingly makes a false statement of a material fact Is guilty REMOVAL FROM REAL PROPERTY
®of a felony,and upon conviction may be punished by a line,imprisonment,or both. (RCW 46.12.210)
MANUFACTURED HOME
TPO i PLATE NUMBER YEAR MAKE LENGTH/W TH(FEET) I HICLE IDENT ICATION NUMBER.(VIN)
V56345 70 . Brook i / 44T/24
111
'LAND 2060
LEGAL DESC N PAGE 2
MANUFACTURED HOME WILL BE EXAFFIXED ❑REMOVED REAL PROPERTY TAX PARCEL NUMBER
821 182 003,821 186 201,821 182 010
LOT
L 2 BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER.SECTION
ii 18-28-1E • NW
® GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER NUMBER OF RE(ISTEF_ED'OWNERS
. 2 NUMBER OF LEGAL OWNERS
NAME OF REGISTERED OWNER 1
DOL CUSTOMER ACCOUNT NUMBER Earnest L.Slagle
• NAME OF ADDITIONAL REGISTERED OWNER
DOL CUSTOMER ACCOUNT NUMBER
Nancy J. Slagle
ADDRESS ' CITY STATE ZIP CODE
2203 Beaver Valley Road Port Ludlow WA 98365
NAME OF LEGAL OWNER
• DOL CUSTOMER ACCOUNT NUMBER
Washington Federal Savings
NAME OF ADDITIONAL LEGAL OWNER
DOL CUSTOMER ACCOUNT NUMBER
ADDRESS T� CITY STATE ZIP CODE
191 W. Washington St., P.O, Box 2848 Sequim WA 98382
GRANTEE
NAME
Earnest L. Slagle and Nancy J. Slagle
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT UWE AM/ARE THE G ED ER(S)OF THIS VEHICLE
AND THIS INFORMATION IS ACCURATE:
Signature of Registered Owner and Title,IF APPLICABLE
Signature of Additional Registered Owner and Title,IF APPLICABLE a-pot
Ni ' -SEALQ f . NOTARIZATION/CERTIFICATI OR EGISTERE OWNER(S)SIGNATURE
� �PN•T• `''4 /// State of Washington
o ti j /� igned or attested
�Qj •; .,• to .•: County of Jeffersor. b p on 2 -
TA P nnS
t� s4 R r- •�S by Earnest L.Slagle Si:... re lift,/ ��
Exp. 0211 3/2 0 1 0% Z - PRINTED NAME OF REGISTERED OWNER '-,Ir;.` S ,�,w•,��
�RAr
•• PUBL‘�' k) by Nancy J.Slagle Beth. y Sint.-
-7 ` PRINTED NAME OF REGISTERED C,,WNER . �I • AME OF NOTAR
//// •••••�••••••.•�` N� Title County/Office No.OR
v, QF W Ash\ \\\1 Notary Public AND: Dealer No,OR 2- 1 '1_2 01 0
/0�� 111,\\\\ DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date
4 TITLE COMPANY CERTIFICATION
I certify that the le_al descri.tion of the land and ownershi.is true and r:orrect per the real property records.
NAME(TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER
Jefferson Title Company (360)38S-2000
SIGNATURE/POSITION DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
III BUILDING PERMIT OFFICE CERTIFICATION
I certify that: O the manufactured home has been affixed to the real property as described.
a building permit has been issued for this purpose and the attachment will be inspected upon completion
NAME(TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE b BLDG PERMIT#
SIGNATURE/POSITION DATE
TD-420-729 MANUF HOME APPL(R/2/02)EXT(W)Page I of 2