HomeMy WebLinkAboutLog001
FROM '~UplJEFFCO
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3603855945
PHONE NO.
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Mar. 18 2005 10:58AM Pi
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JEFFERSON cor
DEPARTMENT OF COMM~
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621 Sheridan Street. Port Towns:
360/379-4450' 800/831.2678 . 360/S79~40 I rO^
Pre-Application Conference
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Fax #
The Jefferson County Unified Development Code (UDC) requires that before an application is made for all Type II end
Type III project applications and Type I applications propo$ing jmperviou$ surfaces of ten thousand (10,000) $quare feet
or more atld/or non~single family structures of five thousand (5.000) square feet or more, a pre-application consultation
must be held. The consultation includes preliminary review and administrative assistance. This service does not include
extensive field inspection or correspondence. Pre-application consultation does not limit subsequent administrative
review.
At the conference, Department of Community Development personnel $hall provide the applicant with;
(1) A list of the requirements for a completed application;
(2) A general summary of the procedures to be used to process the application;
(3) The references to relevant code provisions or development standards that may apply to the approval of the
application: and
(4) A list of any applicable hourly review fees that may be charged by one or more County agencies upon the ~
filing Of a project permit application with the County.
Discussions at the conference or the information provided by the staff shall not bind or prohibit the County's future
application or enforcement of all applicable laws and regulations. No statements or assurances made by County
representatives shall in any way relieve the applicant of his or her dtJty to submit an application con$istent with all relevant
requirements of County, state and federal codes, laws. regulations and land use plans.
NAME: _. f>llbh~ UtttL~ DlS~'I'cr (P00) v.w.~ l
MAILING ADORESS: P-Q- ~oJ'6 Z. q PQ>(.. r LWLoc.k: W"
TELEPHONe: (HOME) 34:>Q ~~r ITdO lG..~O-"}. _ (WORI<) o~
REPRESENTATIVE;; ~ Pa.~~ -;01
MAILING ACORESS: <5 ~
TELEPHONE: (HOME) G~ (WORK) & ~
1. Please answer all Questions on this form completely.
2. Attach a sketch of the Conceptual Design for the proposed use or activity, showing the following information:
a. Vicinity sketch;
. b. North arrow and scale;
c. Property boundaries and identification of land uses on adjacent propQrties;
d. Means of ingress and egress;
e. Propertyllot drainage;
f. Possible locations of sewage disposal and water supply systems;
9. Location of utility easements; and
h, Proposed location of buildings. including setbacks to property boundaries.
3. Attach payment of the appHcab the Jefferson County Fee Ordina .~.
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P~E~PPCONFE;RENce.ooc REV.04t5age
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FROM : RUD~JEFFCO
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Mar. 18 2005 10:59RM P2
PHONE NO.
3603855945
Property Description
General Location; _, /l.1 a !Ui{JJl//smNc..
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SR-U&-
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Legal Description (from Property Tax Statement):
MLlIlIuJWJ
9-Digit Parcel Number (from Property Tax Statement):
Total Acreage: N,/ ~ ~ Zone: IV / JJ-
Applicant (J OWner
o Contract PUrchaser
% Lot Coverage: --f:!../ A-
CJ Lessee '
o other J1.J..,u NCL () t:tiJ
Project Description
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Property OWner (name and mailing address);
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Standard Disclosure
l!lfonnation provided to a prospective applicant during the pr~application consultation is .based on County regulations in effect at the
tIme. of ~he pre.appl~cation consultation. Revised or new County reauJations could affect a future development acolication. A pre-
application consultation does not vest a future development application.
By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their
knowledge, I also certify that this application is being' made with the full knowledge and consent of an 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 Jeffe'rSOn County against all liabilities, judgments. court costs, reasonable
attomey'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.
A and right of en~to pplicant's property snail be requested and shall occur only during regular business hours.
<J . 'S G-P. ~ If /lidU, cfI U/rJr
M/J.M.a..q.e.1t.- (DATE)
I hereby designate ~. G P a/l-iLU I . P FE to act as my agent in matters related to this pre-application
Q";... j L - lil1l.tlJ€U Jod r
~~~GNATURe) (OATE)
LOG \TEM
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PRE-APP CONFeRENCe.coe REV. 0<1/22/2003
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LEGEND
Proposed water lines
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PHONE NO. 3603855945
Mar. 18 2005 10:59AM P3
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arrowstone Island
Indian Island
LOG ITEM
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PROJECT MAP FOR
LOCAL UTILITY DISTRlCT #14
MARROWSTONE ISLAND
WATER SYSTEM
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