HomeMy WebLinkAbout02- Supplemental ApplicationCOUN DEPARTMENT OF COMMUNITY DEVELOPMENT SON
621 Sheridan Street. Port Townsend, WA 98:368
FERS
Tel: 360.379.4450 | Fax: 360.379.4451
Web: www.co.jefferson.wa.us/communitydevelopment
ASH E-mail: dcd@co.jefferson.wa.us
NGTO
SUPPLEMENTAL APPLICATIONN
SITE DEVELOPMENT REVIEW -Legal Lot of Record Determination
421u8O5 PROJECT/APPLICANT NAME: PARCEL #
PURPOSE
The purpose of the site development review (SDR) legal lot of record determination process is to provide
owners or developers of land a means to verify legal status of lot(s) and whether the lot is eligible to
receive development pemit applications. The SDR process implements Chapter 18.40 Jefferson County
Code (JCC) and Chapter 18.12 JCC.
PROCESss
Submit the standard Permit Application along with this Supplemental Application (and the SDR Buildability
Analysis supplemental application, if applicable).
Department of Community Development (DCD) will review property history information to determine whether the
lot was lawfully created.
SUBMITTAL REQUIREMENTS
Required Submittal Items
Permit Application
Supplemental Site Development Review Application
Submit one of the following?
Title Report or Title Commitment
Recorded Plat: Volume & Page or associated Auditor File Number (AFN): .
1 Additionail documentation may be required duning the site development review process. incuding but not limied to crtical areas
reports, State Environmental Policy Act (SEPA) checklist, or septic system documentation.
2. As a part of initial submission of the SDR application, DCD may require additional documentation
demonstrating that a lot was lawtuly created. Submit at least one of the listed documents veritying legal creation
of the lot and be advised that further documentation may be required.
Do you own any adjacent lots?
do hereby swear and certify that in
addition to the land subject to this application (circle the phrase below that applies):
I have no interest in I have an interest in
land adjacent to any portion of the subject lots by reason of ownership, contract for
purchase by agreement or option by any person, family member, fim, or corporation in any
manner connected with me or the development.
The applicant hereby certifies that the site development review and any associated applications are
an accurate representation of the property information and proposed development. The applicant
hereby acknowledges that any approval issued on this application may be revoked if any such
statement is found to be false, and that site development review shall not constitute vestng or
authority to commence development per limitations at JCC 18.40.490:
Signature:4 Name: AMA MBuun Date: 13J02A
OFFICE USE ONLY
Site Development Review Permit Fees
Legal Lot of Record Determination ($102 hourly rate applies, if required) DCD018 $ 102.00
Scan Fee DCDO22 $25.50
Site Visit Fee -only if site visit is required ($204) DCD018
Subtotal
Technology Fee DCDO03-5%
Total Fees*
Environmental Health and Public Works fees may be required as part of the SDR process.
Additional fees may apply.
Receipt # Date Cash/Check/CC: