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621 Sheridan Street · Port Townsend · Washington 98368
3601379-4450'800/831-2678'360/379-4451 Fax
Land Division Supplemental Application'
MLA # 0 $ - C)\::) 'Z.. W (q
PROJECT/APPLICANT NAME: Discovery Bay Planned Rural Residential Development
Submittal Requirements
1. A completed Master Land Use Application and State Environmental Policy Act (SEPA) Checklist (If applicable).
Representative authorization is required if application is not signed by owner.
2. Short Plat, Long Plat or Binding Site Plan application fee (as applicable), as set forth in the Jefferson County Fee
Ordinance, as amended.
3. Any supplemental information identified by the Administrator.
4. Five (5) paper copies of a preliminary plat meeting the requirements of Unified Development Code (UDC) Sections
7.3.3 and 7.3.4 for short plats, or UDC Sections 7.4.3 and 7.4.4 for long subdivisionslbinding site plans and identifying points of access, all
easements, deeds, restrictions, or other encumbrances restricting the use of the property, as applicable. Copies of the applicable UDC
sections are attached for your use.
5. Where site conditions require a special report to assess or address any probable significant adverse environmental
impacts, a study (or studies, as applicable) prepared by a competent professional may be required if deemed necessary by the
. Administrator.
6. Evidence of compliance with UDC Section 6.7, Stormwater Management Standards, as deemed necessary by the
Administrator.
7. The preliminary plat must be prepared in accordance with UDC Section 7.3.3 for short plats, or 7.4.3 for long plats. The
contents of the preliminary plat must provide the information listed in 7.3.4 for short plats and 7.4.4 for long plats.
8. The following supplemental information:
Subdivision Name:
Discovery Bay
Planned Rural Residential Development
X Residential
200:!: Acres
. Commercial
. Industrial
. Individual Wells X Commun' Water S stem
Community System(s) & Individual, where soils allow
Minimum Lot Size: .3 Acre
Open Space: 154.2 Acres
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I See UDC Section 7. Use this aF>plication for Preliminary Plats (short or long) and for Mixed Use, Commercial and Industrial Binding Site Plans; a
separate application is available fur Residential Binding Site Plans. LOG I TE M
LAND DIVISION APP.DOC REV. 4/3/2001 # 1 Page 1
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9.
I, Michael Asmundson, Ownder/ManaQer, do hereby swear and certify that in addition to the land subject to
this application (check the box below which apPlies):
X I have no interest in
o I have an interest in
land within 300 feet of any portion of the subject property by reason of ownership, contract for purchase by agreement
or option by any person, family member, firm, or corporation in any manner connected with me or the development.
SIGNATU';;J-IuiPd~
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OA TE -
10. The applicant hereby certifies that the preliminary plat provides an accurate representation of the proposed land
division; and the applicant hereby acknowledges that any approval issued on this application may be revoked if any
such statement is found to be false.
SIGNATUR~~a~
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LAND DIVISION APPDOC REV 4/3/2001