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HomeMy WebLinkAboutBLD2000-00421 BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX(360)379-4451 (800) 831-2678 PERMIT #: BLD00-00421 Received Date 06/22/2000 SITE ADDRESS: 752 RHODODENDRON LN Issue Date 11/16/2000 BRINNON, 98320 Expiration Date 11/16/2001 APPLICANT: DAVID M PRINTZ PHONE: LINDA D PRINTZ 6564 SW HICKMAN LN PORTLAND OR 97223-3422 SUBDIVISION: PLEASANT TIDES Block: Lot: 24 PARCEL NUMBER: 988500024 Section: 15 Township: 25 N Range: 02 W CONTRACTOR: BISHOP BROTHERS CONSTRUCTION PHONE: (360)385-2441 PO BOX 417 PORT HADLOCK WA 98339 Contractor's License: BISHOBCO93D6 Expires: 12/14/2000 LOAN LENDER/ RALSTON RALSTON BOND HOLDER: PROJECT DESCRIPTION SINGLE FAMILY RESIDENCE REQUIRED INSPECTIONS: [ � CFootings/Setbacks (Shoreline Setback o K �io ,, C [_vr Foundation: e5K , 4 - 0 [ ] Underground Plumbing/Underground Insulation: [ ] Shear Wall: [:. ..rami Plumbing) C7.3 Ic -3,y__ [ ] Propane Tank/Lines: -7 li'' cwee.144-e r [ ] Insulatiio�n:: t< "�--Z43—c / [ c Sh tr� : . Q'I .t_Cf Final/Occupan val: � � // ((�r ( HEALTH DEPARTMENT APPROVAL REQUIRED PRIOR TO FINAL INSPECTION. THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. Inspector's Phone Hours 8:00 a.m. - 9:00 a.m. SPECIAL CONDITIONS MAY APPLY SEE REVERSE HOT LINE AVAILABLE 24 HOURS A DAY 3 i BUILDING PERMIT` A 'LICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00421 Received Date: 6/22/2000 SITE ADDRESS: RHODODENDRON LN 01 CV- BRINNON, 98320 APPLICANT: DAVID M PRINTZ PHONE: (503)244-0869 LINDA D PRINTZ 6564 SW HICKMAN LN PORTLAND OR 97223-3422 SUBDIVISION: PLEASANT TIDES Block: Lot: 24 PARCEL NUMBER: 988500024 Section: 15 Township: 25 N Range: 02 W CONTRACTOR: BISHOP BROTHERS CONSTRUCTION PHONE: (360)385-2441 PO BOX 417 PORT HADLOCK WA 98339 Contractor's License BISHOBCO93D6 Expires 12/14/2000 ARCH ITECT/ BROCKMAN ENGINEER : 7820 SW LINDEN RD PORTLAND OR 98370 PROJECT DESCRIPTION: SINGLE FAMILY RESIDENCE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP Oo NEW MAIN: 1;379 ` ' VALUATION 1� 430,464.00 ADD'L: 951 ' HEAT TYPE: PRO CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: 3 SHORELINE: CONST TYPE: DECK: i`7—C� SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PUBLIC PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: 2 Prop: 3 Seismic Streams Total: 2 Total: 3 Flood Way Flood Plane F&W Landslide Routing Date: Shoreline Aquifer Forest: Commercial Rural —Proximity - flat C d dons Type Amount Paid By: Date: Receipt: Approve��ate Permit $1,167.35 MAM 06/22/00 32007 /► F['�®O` /C D Plan Check $350.21 MAM 06/22/00 32007 /"� r R V C State Building Code $4.50 MAM 06/22/00 32007 \.D -et— L-N-3 °rt) - \ Potable Water Application $30.00 MAM 06/22/00 32007 NOV 1 6 2000 Total: $1,552.06 Jefferson County Planning &Building Department I:\F_BLD_App_Bld.rpt 10/29/99 ' i Jefferson County Department of Community 3eveilgin8 It ��gsozv C'0 621 Sheridan Street.Port Town nd WA 88368(3601378-4450 Po � 0 00 �1oQoo�� Project Description: Build' ype: Project Type: Frame Type: amily � - - ❑ Garage Attached/Do: ❑ Addition E Steel Modular ❑ Alteration/Remodel ❑ Concrete • Commercial ❑ Repair 2 Masonry Multi-family/#of Units ❑ Demolition ❑ Other._ ❑ Industrial ❑ Other. Bedrooms: Bathrooms: Type of Sewage Disposal: Type of Heat: Choose one: Existing: Existing: ❑ Sewer U Community System ❑ Electricity 2 Oil Proposed: c-2, Proposed: 3 ndividual System ❑ Woodstove P-eepane Total: �. Total: -3 If not sewer,fill out the following: Heat Pump Conventional temative ❑ Other Permit# SEP Water Supply: /� � ❑ Private well ❑ Two Party Well❑ Public:Name of water system: / , �' ,� D 3 3/ c Square Footage: p- 7 7.$O For Office Use Only IMai�n Floor /a)O -�..� - I UBC OCCUPANCY GROUP 2ND Floor /0 A I - r Base fee t 1�a7. ' S 3r Floor --- 54.35 Plan Check fee s�, Z Htd Basement State Surcharge fee y � U..td Basement Subtotal to tJ ZZ 0 , a:e/Carport "----1(D0 *c__ dD 7�0 Pot Water Review fee _ Decks /.` .0 150D 911/Rd Approach fee J I .OV Commercial TOTAL ((0 3. b Industrial Receipt # - 'Z00 Or Date to•2-1.'06 Estimated Cost: If within 200' of the Shoreline, Distance to Bank or Ordinary High Water Mark 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 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 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: , 12.0.rj £ .e. 1 /Date: (.� o2a7 a ) Jefferson County Department of Community Development 'April 26, 2001 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: WILLIAM E HUNT CO 1237 LAKE SAMMAMISH PY SHORE LANE SE ISSAQUAH WA 98029 Critical Area Review Case Number: CAR98-00322 Project Description: New sand filter septic system. Parcel Number: 988500024 S-T-R: 15-25N-02W Site Address: 752 RHODODENDRON LN BRINNON WA, 98320 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 11-18-98 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: shoreline. 2.) This waiver also includes findings and conditions for evaluation of shoreline areas as regulated under the provision of The Jefferson County Shoreline Management Master Program, adopted March 7, 1988, as amended. 3.) The standard setback for residential structures, including common appurtenant structures such as garages and workshops, shall be 30 feet, or 1 foot for each foot of bank height, whichever is greater. This setback shall be measured from the bank's edge when the bank height exceeds 10 feet. 4.) According to submitted plans, the bank height along this property is approximately 25 feet. 5.) The bluff height is approximately twenty-five (25)feet. The required setback from the top of the bluff is thirty feet. 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 being revoked and the application becoming subject to further review. CONDITIONS OF APPROVAL: 1.) A minimum setback of 30 feet shall be permanently maintained as a fish and wildlife habitat area buffer associated with the shoreline. This buffer shall be measured perpendicularly from the ordinary high water mark along the shoreline. 2.) 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. 3.) All construction activities, including the storage and preparation of materials, shall not encroach upon the designated fish and wildlife habitat area, its associated buffer, or any critically important plants and trees identified on the subject property. 4.) Damage to vegetation to be retained on site shall be minimized by directional felling of trees away from these areas. 5,.) The proposed development shall be located on the subject property exactly as identified on the Universal Plot Plan, or other Site Plan, approved by the County as part of the triggering permit application. Applicant shall be responsible for contacting and notifying contractor(s)'of the above conditions in order to ensure compliance at various stages of construction/development. 6.) Residential structures shall not exceed thirty-five (35)feet in height. Warren Hart, AICP Date Critical Areas Administrator 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 Department of Community Development. Applicant's Signature Date c: File is\F_CAR_Waiver_W_Conds.rpt 12/13/99 :A . BUILDING PERMIT APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD00-00421 Received Date: 6/22/2000 SITE ADDRESS: 152 RHODODENDRON LN BRINNON, 98320 APPLICANT: DAVID M PRINTZ PHONE: (503)244-0869 LINDA D PRINTZ 6564 SW HICKMAN LN PORTLAND OR 97223-3422 SUBDIVISION: PLEASANT TIDES Block: Lot: 24 PARCEL NUMBER: 988500024 Section: 15 Township: 25 N Range: 02 W CONTRACTOR: BISHOP BROTHERS CONSTRUCTION PHONE: (360)385-2441 PO BOX 417 PORT HADLOCK WA 98339 Contractor's License BISHOBCO93D6 Expires 12/14/2000 ARCH ITECT/ BROCKMAN ENGINEER : 7820 SW LINDEN RD PORTLAND OR 98370 PROJECT DESCRIPTION: SINGLE FAMILY RESIDENCE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,379 VALUATION 130,464.00 ADD'L: 951 HEAT TYPE: PRO CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: OTHER: SHORELINE: V CONST TYPE: GARAGE: 150 SETBACK: 0) DECK: BANK HEIGHT: SEWAGE DISPOSAL: ALT (d L, CA WATER SYSTEM: PUBLIC PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA O _ Exist: Exist: Wetland k Erosion 00 Prop: 2 Prop: 3 Seismic ,onStreams N Total: 2 Total: 3 Flood Way ,/QO Flood Plane N;1 Routing Date: F&W il,t) Landslide N)S) /i�- %^ Shoreline 6U,hJ m Aquifer 1)c) �S/ Y../ Forest: Commercial t,,,O Rural ye) —1-'r xlrrut - a/u Plat U d Ions i " Type Amount Paid By: Date: 'Receipt . p Appro. ea —�-°� Permit $1,167.35 MAM 06/22/00 32007 47 icai `i Plan Check $350.21 MAM 06/22/00 32007 0 State Building Code $4.50 MAM 06/22/00 32007 (I� v -ieview(07 Potable Water Application $30.00 MAM 06/22/00 32007 Total: $1,552.06 'Atormwater Bp /,,_W j %, Alet*AA (2u..2L I:1F_BLD_App_Bld.rpt 10/29/99 R , STORMWATER CALCULATIONS Owner/Applicant: CIPROPOSED LAND DISTURBING ACTIVITY Site Address: igA0/�x7412,)Z Drainfield area cleared iy coo sq.ft. Driveway Length Z© ft. `6 X Width IS ft. 9 Digit Parcel Identification No.: '�/ ,7 29 GI2 = Total Driveway 3c 0 sq.ft. Permit Number: Clearing and Grading for Site Development PLOT PLAN (Well/Structures/Utilities/etc.) sq.ft. 600 sq.ft. INDICATE the following information. Total Land Disturbance f Qoo sq.ft. Draw entire parcel to scale. Indicate scale of plot plan: Aco One i equals! ❑ IMPERVIOUS SURFACE Proposed Structures (all roof area) /i O sq.ft. ❑ 1. North arrow Existing Structures (all roof area) --fa- sq.ft. • 2. All property boundaries and dimensions Sidewalks /2c; sq.ft. ❑ 3. Names of adjacent streets Concrete Patios — sq.ft. ❑ 4. Driveway/s & parking spaces Proposed: ❑ 5. Major features such as ravines, Driveway Length 2c> ft. seasonal creeks, bodies of water, etc. X Width /S ft. ❑ 6. Septic tank, drainfield and reserve area location, = Total Driveway Ice sq.ft. existing or proposed, and distance to Total Impervious Surface 2, SOO sq.ft. closest structure ❑ 7. Sewer lines The Stormwater Manual sets forth the following Small Parcel Minimum Requirements: 8. Wells and/or water lines • Construction Access Route Stabilization: ❑ 9. Neighboring wells within 150 feet Construction vehicle access shall be, whenever feasible, limited to one route. Access points shall be stabilized with ❑ 10. Paved surfaces (patios) quarry spalls or crushed rock to minimize the tracking of ❑ 1 1. Structures, existing and/or proposed sediment onto public roads. If sediment is inadvertently transported onto public roads, roads shall be cleaned ❑ 12. Setbacks (distances to property thoroughly at the end of the day by shoveling or sweeping. Street washing should only be done after the bulk of the boundaries, structures, banks, sediment has been removed by sweeping. and shorelines) • Stabilization of Exposed Soil: All exposed and unworried soil shall be stabilized by sodding, ❑ 13. Easements for access or utilities seeding, mulching, plastic covering, application of gravel base ❑ 14. Arrows showing direction of slope-- on roads and driveways, or other appropriate means within seven days during the period from May 1 to September 30 assume an elevation of 100 feet at one and within two days during the period from October 1 to April lot corner and indicate the other lot 30. Mulch shall be applied to a minimum depth of two inches. • Protection of Adjacent Properties: corner elevations in relation to it Adjacent properties shall be protected from sediment deposition by appropriate use of vegetative buffer strips, sediment barriers or filters, dikes, mulching, or by a FOR APPLICATIONS ADJOINING SHORELINES, combination of these measures and other appropriate Best Management Practices (BMPs). INDICATE: • Maintenance: ❑ 15. Ordinary high water mark All erosion and sediment control BMPs shall be regularly inspected and maintained to ensure continued performance of ❑ 16. Top of bank, if over 10 feet high their intended function. ❑ 17. Slope of bank in degrees • Other Appropriate BMPs as required by Jefferson County to mitigate the effects of increased runoff shall be applied. H:\HOME\PLN CNTR\FOR MS\PLOTPLN.FRM9/97 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 SHERIDAN ST., PORT TOWNSEND, WA 98368, (360) 379-4450 SHORELI SET ACK EVALUATION f� APPLICANT: Gr�l/ or �;, ADDRESS: Sw �� �� TELEPHONE: Sc�� �S/ / U�'�i vu> 3� -3x.�=a yyfi PROPERTY DESCRIPTION SITE ADDRESS �� O - TAX PARCEL NUMBER: •-s0 Q 077 PROPERTY DESCRIPTION: cZ ,9 y Pr,//6/ . - 2Z. ADJACENT WATER BODY: Bluff Height: c,7 t Source: Bluff Stability: Source: Where the bluff is less than 10 feet the minimum setback is 30 feet. This setback shall be measured from the ordinary high water mark (OHM) to the most waterward edge of the proposed structure. • SETBACK FROM OHM: j feet Where the bluff is 10 feet or greater the minimum setback is 30 feet or one foot for every foot of bluff height to a maximum of 100 feet. Setbacks are measured from the bank's edge to the most waterward edge of the proposed structure. • BLUFF SETBACK: 30 feet If you wish to have your shoreline setback evaluated in relation to that of the closest existing residences, please submit the following information: Nearest House within 300 feet on the Right of proposed structure (facing waterward): • Setback from bank or ordinary high water mark (OHM): feet • Distance to proposed structure: feet Nearest House within 300 feet on the Left of proposed structure (facing waterward): • Setback from bank or ordinary high water mark (OHM): feet • Distance to proposed structure: feet Setbacks shall be measured from the bank's edge to the most waterward edge of the structure. Please attach a plot plan showing the nearest residential structures and their shoreline setbacks. 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. (7. Va)..Grr. � �� a7aOD Signature Date Page 1 of 2 •J unty Department of Community Development __1 oneridan Street,Port Townsend WA 98368 (360) 379-4450 w�_ ) Universal Plot Plan Fill in the following blanks as completely as possible: Project Description: • 4-/% 4AV-P-( I 9 Digit Parcel Identifi t���nb (Srom our statement): Site Address c 911#: Road Name2,�j0-21, , Aek Zip Code: Legal Description Subdivision Name: %%�� �a2',2i :4' Block: Lot(s): c V Section: /5- Township: a� Range: O?� Parcel Size (acres or square footage): 6 D ,(/ 3 Property •�Owner7_ Phone: Mailing Addressc .sw y Applicant/Occupant: Phone: (if different from owner)x2, _e Mailing Address: Authorized R-.• . Phone: /P"' _...---12e)a-/-/_)c.c.,) -3?-5Thq W7 Mailing Ad.. - i� : %! -7 giVec r/"/adt(id? //t//t2-. p f-E 3/ General Contractor: y62,4-- �� cis: Or Manufactured Home Installer:L/ p�0 , / Phone: �yy/ Mailing Add®-•CJ. &k / /7 �� LEI C�d/g-d? !/(i/1-- i'1-.3 _? Contractor's State Lice er Expiration Date: Septic Designer Phone: Mailing Address: Architect:/Engineer: &/2.e.96-/f- P1253 a99o?- /9 c7 Mailing Address: /� G. !/ i " L%1/(/LL2'i`l/ -7.2 025 Loan Lender/General Phone: Contractor's Bond Holder: 7,��..P_, �Z.... i�-t- 00.42), �S -cF `7/-S_ Mailing Address: FOR OFFICE USE ONLY Fire District: Planning Area: School District: Zone: 1/00 H:\home\pincntr\forms\universal plot plan JEFFERSON COUNTY STORMWATER MANAGEMENT ORDINANCE SMALL PARCEL EROSION AND SEDIMENT CONTROL PLAN EROSION AND SEDIMENT CONTROL WORKSAEET � Property Owner: L.,,vrj y /9,fitJ Telephone:. g f' .v,9/ Address: ,4o. /7 /n2TPf/3,i7,f.66,e c.t;; Assessor's Parcel Number: '! SO o,zy Building Permit or Septic Permit Application Number(if applicable): Brief Project Description: /W , /fo.'ti 5z;///7c< Site Location: csi i VX- z Person Responsible for BMP Installation and Maintenance: L o ti ds/Sr rci; -? Address: Po y/ 7 ,' rr /Wz7Lacl� t Telephone: ifs 2 yv/ 1. Describe/check the Best Management Practices (BMPs) that you will implement during land disturbing activities or construction to control erosion and prevent sediment from entering water bodies (marine waters, streams, rivers, lakes, or wetlands) or impacting adjacent property or roads. Please check the measures you plan to implement and show their approximate location on the site plan. You may also propose measures other than those listed. Attach additional sheets, if more space is required. [J/" Stabilize construction access route. Limit construction vehicles to one route, if feasible. Provide a stabilized construction access by applying quarry spalls, ballast, or crushed rock to minimize tracking sediment onto roads. (See attached illustration from Stormwater Management Manual.) If sediment is transported onto roads, they will be cleaned thoroughly. [:4' Minimize the extent of land disturbing activity and preserve existing vegetation. Preserve buffers of well-established vegetation between disturbed areas and property boundaries, roads, water bodies, and designated critical areas (wetlands, fish and wildlife habitat areas,landslide or erosion hazard area,etc.). SPESC Instructions—Short Form Revised June 3, 1999 3 EROSION AND SEDIMENT CONTROL WORKSI EET [,4' Phase clearing so that only areas that are actively being worked are uncovered. Start and complete land disturbing activities and stabilize the site between April 1 and September 30. Stabilization means that disturbed areas will have well-established plant cover or be landscaped to minimize erosion. [] Stabilize exposed soil Exposed and unworked soil will be covered within 2 days between October 1 and March 31 and within 7 days between April 1 and September 30. [ ] Cover exposed soil with a minimum of 2 inches of straw or hay or other material approved for this purpose. [ ] Cover soil stockpiles with plastic sheeting and locate away from water bodies, roads, and property lines. [] Place gravel base on roads,driveways,and parking areas after clearing and subgrade preparation. [] Protect adjacent properties and water bodies from sediment deposition: ['lace straw or hay bales in ditches and drainage ways down slope from areas of land disturbing activity to filter runoff before it leaves the project site or enters water bodies. (See attached illustrations from Stormwater Management Manual.) [y]'Install a filter fence down slope from areas of land disturbing activity to filter runoff before it leaves the project site or enters water bodies. (See attached illustration from Stormwater Management Manual.) [.j" Regularly inspect and maintain all BMPs especially after storms events. [] Describe other erosion and sediment control Best Management Practices. Be specific as to design and specifications. SPESC Instructions—Short Form Revised June 3, 1999 4 • EROSION AND SEDIMENT CONTROL WORKSHEET 2. Describe how disturbed areas will be permanently stabilized (seeded, landscaped, apply gravel base to roadways, etc.) !VLcv co-rxr iz 6-4Ll L< ?sC 1-''. et-4/771 Gilled/0 71 I/_. L,%70 77c,') 3. Describe how runoff from impervious surfaces will be controlled (disperse to vegetated areas to infiltrate, dry well,infiltration trench,route runoff to existing drainage facilities,etc.). /0LL. PGX.)Olz7z 1—0714 .dG tntJC 6/Tc Tz , ,1i 2_/A,,,,ld 7d SPESC Instructions—Short Form Revised June 3, 1999 5 EROSION AND SEDIMENT CONTROL WORKSHEET 4. Specify your construction sequence. Describe the timing of all land disturbing activities (clearing and grading, construction, installation of drainage facilities, landscaping, etc.) and Best Management Practices.Describe proposed maintenance of BMPs. et,c9tz i,e r, s,7l'c'/C . .cdi#C/L F=/LL 'DtSN0,4770/Cd /j/ '.12 ..tek' 'Y7C /i/(t.sttLLS,C1 /tA,e77}Z /i4 Ili c'C/7l�ij�G The Best Management Practices proposed above will be implemented to control erosion, sediment, and stormwater runoff. I will notify the Permit Center for inspections as required. Sign e of Owner/Agent Date SPESC Instructions—Short Form Revised June 3, 1999 6 Jefferson County Department of Community Development • 621 Sheridan Street, Port Townsend, WA 98368 CRITICAL AREAS QUESTIONNAIRE Applicant Name ��,� ,� ✓2G Building Application _ Land Use Application _ Shoreline Application On-site Sewage Application — Subdivision Application Other: 1 . Is there any standing or running water on the surface of the _ Yes / No property or on any nearby property at any time during the year? If YES, please describe: 2. Has any portion of the property or any nearby property ever been _ Yes No identified as a wetland or swamp? If YES, please describe: 3. Are any willows, skunk cabbage, alders, or cottonwoods present _ Yes No on your property or adjacent properties? If YES, please describe: 4. Are there any indications on any portion of the property or on any _ YES No nearby property of rockslides, earthflows, mudflows, or landslides? If YES, please describe: 5. Please indicate which line best represents the steepest slope found on your property. (Check appropriate box) 0 0 4 Q c O 0 r r r r r i i r r r r r i i r r r r r i i iiiiii i it it rrr i� i,i i' -- r rr rr rr r r rr ir i � /,7 �' /.' rrrrri i rrrrrri fl (Questionnaire Continues on Back) Page 1 of 2 6. Does the site have steep slopes with little to no vegetation? YES -No. If YES, please describe: 7. Does the site contain high percentages of silt and/or very fine YES sand? If YES, please describe: 8. Does the site contain ground water seepage or springs near the _ YES /NO surface of the ground? If YES, please describe: 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 P1,2-.2_adc) FOR OFFICE USE ONLY ❑ Wetlands ❑ Seismic CRITICAL AREAS ON OR ❑ Aquifer Recharge Area (zone_) ❑ Fish & Wildlife Area 1 IMMEDIATELY ADJACENT TO SITE: ❑ Frequently Flooded Area ❑ Fish & Wildlife Area 2 ❑ Erosion ❑ Landslide ❑Seismic ❑ Commercial Forest Section Township North Range Parcel Number: Parcel Size: Comprehensive Plan Land Use Designation: Reviewed by: Community Plan: Date: Page 2 of 2 h:\home\pincntr\forms\car.doc 1/00 fl i 3NVmf NftlCN3COCOHbi � m ® N Q J Q � � a u ® r-------------------- ® x rq� iuu�i aKv�ir�uiwa�aini L it I r------ --- - — ® I I — — — — — — — — — — — — — — — — — — — �I M r�i I III I G I III I �I It I II � III I I I� T III IL III III III I II a WIII YLI e a a ® IL o ly I .m-r9 V r ------=---- ��._------�-------r----'dam=-.I.J I min ru— — — - - - - - - _ - - - - ®-- IL--- I I a n u u ® r--------¢--------�---- ' I I--------- —------------ 9� 0 RN"Ift"Q_?Lf- - p( I ED � i z U u cD r--1 9 I I- m. �£ err rueiG on�m a ~ I a----------------BN—mo-- � ---- QI N Cly I ------------ i I I I I I n i I y Icl �I I ❑ I I W U M1 i '7'�dNt,= I G 0 d I 's I� ❑ ❑ I 7 I z 1L