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Home My WebLink AboutBLD2000-00470 • • JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST, PORT TOWNSEND WA 98368 MANUFACTURED HOME INSTALLATION PERMIT APPLICATION ❑ NEW BUILDING REPLACEMENT SIZE (42('? I YEAR i'A 911 MAKE 3\r1 h COST 001 BEDROOMS: BATHROOMS: EXISTING , EXISTING PROPOSED PROPOSED TOTAL TOTAL , TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: J ❑ SEWER 0 COMMUNITY SYSTEM 0 PRIVATE WELL ® TWO PARY WELL 111 INDIVIDUAL SYSTEM 0 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 `/‘O X C.�C J"S P.rCx A r i�j DATE '7 - 0 NAME (PLEASE PRINT) FOR OFFICE USE ONLY BASE FEE 4 I-,. RECEIPT# V ADDITIONAL SECTIONS CASH/CK# \ u SUBTOTAL t14 C DATE / 6 0 \t POTABLE WATER - 67L) C 91 1/ROAD APPROACH —�— TOTAL 7 NANO ME\PLNCNTR\FORMS\MOBILEAP.10/99 , • STORMWATER CALCULATIONS • Owner/Applicant: A" -L,etflalthi 0 PROPOSED LAND DISTURBING ACTIVITY `Site Address: V�v►S tt ✓� J'1��. �l 42— Drainfield area cleared sq.ft. Driveway Length ft. c� X Width ft. 9 Digit Parcel Identification No.: p 2- t Od I O l L = Total Driveway sq.ft. Permit Number: Clearing and Grading for Site Development PLOT PLAN (Well/Structures/Utilities/etc.) sq.ft. -7 2 G sq.ft. INDICATE the following information. Total Land Disturbance Z'v sq.ft. Draw entire parcel to scale. Indicate scale of plot plan: One inch equals 0 IMPERVIOUS SURFACE ^7 Proposed Structures (all roof area) ( 2 Usq.ft. ❑ 1. North arrow Existing Structures (all roof area) g ()CC) sq.ft. • 2. All property boundaries and dimensions Sidewalks sq.ft. ❑ 3. Names of adjacent streets Concrete Patios sq.ft. ❑ 4. Driveway/s & parking spaces Proposed: O 5. Major features such as ravines, Driveway Length ft. seasonal creeks, bodies of water, etc. X Width ft. ❑ 6. Septic tank, drainfield and reserve area location, = Total Driveway sq.ft. existing or proposed, and distance to Total Impervious Surface ,c � � sq.ft. closest structure Ll 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 0 1 1. Structures, existing and/or proposed sediment onto public roads. If sediment is inadvertently transported onto public roads, roads shall be cleaned O 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, 0 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 0 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\PLNCNTR\FORMS\PLOTPLN.FRM9/97 O • MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION • Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00470 Received Date: 7/17/2000 SITE ADDRESS: 2427 SWANSONVILLE RD PORT LUDLOW, 98365 APPLICANT: CLIFFORD N WHITEFORD PHONE: % LISA HULJEV 2427 SWANSONVILLE RD PORT LUDLOW WA 983659780 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821081012 Section: 08 Township: 28 N Range: 01 E CONTRACTOR/ DEALER: stonnwater Rooked 7 20 00,1 • INSTALLER: JAIME KOZELISKY WAINS0626 J 1`/2001 i (360)385-3215 1112 JACOB MILLER RD PORT TOWNSEND WA 98368 t Review 7.2-LLDt}�'( - PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: HOMENET SETBACK: VALUATION 5,000.00 YEAR: 1974 LABOR & INDUSTRIES APPROVAL? SIZE: 60 X 12 BANK HEIGHT: SEWAGE DISPOSAL: CON IR t WATER SYSTEM: 2WELL /1 c BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO STORMWATER: YES NO Exist: Exist: AREA Plat Conditions Prop: 2 Prop: 1 Wetland Erosion Total: 2 Total: 1 Seismic Streams Flood Way Food Plane Routing Date: F&W Landslide Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Permit $141.00 MAM 07/17/00 32195 Potable Water Application $30.00 MAM 07/17/00 32195 Total: $171.00 is\F_BLD_App_Mob.rpt 10/29/99 • MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD00-00470 Received Date: 7/17/2000 SITE ADDRESS: 2429 SWANSONVILLE Issue Date: 9/24/2002 PORT LUDLOW, 98365 APPLICANT: CLIFFORD N WHITEFORD % LISA HULJEV 2427 SWANSONVILLE RD PORT LUDLOW WA 983659780 SUBDIVISION: Block: Lot: 6+ PARCEL#: 821081012 Section: 8 Township: 28 N Range: 01 E CONTRACTOR/ DEALER INSTALLER: JAIME KOZELISKY WAINS0626 Expires: 7/31/200 1112 JACOB MILLER RD PORT TOWNSEND WA 98368 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION MAKE: HOMENET YEAR: 1974 SIZE: 60 X 12 THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 9/24/2003. REQUIRED INSPECTIONS: [ ] Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): a 004 4-sr S&cgs az' FEE 1 F24i►1- Owluse_ [ ] Blocking/Plumbing: 04.4)g [ ] Zoning Approval: [ ] Septic System Approval: [ ] Final/Skirting/Vents/Porches/Steps: HEALTH DEPARTMENT APPROVAL REQUIRED PRIOR TO FINAL INSPECTION BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. - 4:30 p.m. HOT-LINE AVAILABLE 24 HOURS A DAY JeffersonOunty Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 CRITICAL AREAS QUESTIONNAIRE Applicant Name �C?n i.) c3 h\ 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 V 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 y 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) 4 Q 0 iii / / / / i/ ,' �'� / iii / / / iMaif iiiii// '� iii// / / �' .-------- iiiiii/ / 11/ (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 V NO sand? If YES, please describe: 8. Does the site contain ground water seepage or springs near the YES Y 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. - - `� e Cs�� Signature tV1��4{��J'.rL'� 1� � Date .7 x %� 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 0 tr:3: 1 t11 e? • 1 -1( 1 \r7.-f- 1 ..,,N9 i ,..00,0\ 1 , 1 1 \,\ , I 1ME ),..... • Cl A I ----------j \ \ r"''''""*...."'....". itP ‘0,- • 1 '‘. \ I fr 1 \it \\\\ i tt. 1 ,t rat I i r.1 .() a A c )r) t"). 0 — M 46 i v O lam' '�" .0 N 0 o to L_... 0 (1 j�'y a� 0, 0 ! �J U cn a. p. o p. a. 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