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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 (800) 831-2678
PERMIT #: BLD02-00046 Received Date: 1/30/2002
SITE ADDRESS: 1650 S JACOB MILLER RD Issue Date: 2/13/2002
PORT TOWNSEND, 98368 Expiration Date 2/13/2003
APPLICANT: TERESA D TETZLAFF
PO BOX 841
PORT TOWNSEND WA 98368-0841
SUBDIVISION: Block: Lot: T 92
PARCEL#: 001171010 Section: 17 Township: 30 N Range: 01 W
CONTRACTOR/ WASHINGTON HOME CENTER PHONE: (800)648-1113
DEALER PO BOX 176
CHEHALIS WA 98532
Contractor's License WASHIHC0770A Expires 03/19/2002
INSTALLER: KEVIN ALLEN WAINSOO75 Expires: 8/31/200
1951 N NATIONAL CHEHALIS WA 98532
PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION
MAKE: SKYLINE
YEAR: 2002
SIZE: 27 X 56
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 2/13/2003.
REQUIRED INSPECTIONS:
[L4/ Setbacks: d/C 4f-'0 Z-
NT/ Footing(Ifcontinousf t s are se ): OX 3-'`F'0't- (/�i4[-1-f OX C ;j'--S''o �-
tF�JJ CC 5L/1 ®g �i
rr' ' al/Skirling/Vents/Porches/Step;?efl# .S/'ZIT c7-C
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.
SPECIAL CONDITIONS APPLY-SEE REVERSE
HOT-LINE AVAILABLE 24 HOURS A DAY
. MLA02-00047
Review Type: I
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT it: BLD02-00046 Received Date: 1/30/2002
SITE ADDRESS: 1650 S JACOB MILLER RD
PORT TOWNSEND, 98368
APPLICANT: TERESA D TETZLAFF PHONE: (360)344-4208
PO BOX 841
PORT TOWNSEND WA 98368-0841
SUBDIVISION: Block: Lot: T 92
PARCEL NUMBER: 001171010 Section: 17 Township: 30 N Range: 01 W
CONTRACTOR/ WASHINGTON HOME CENTER PHONE: (800)648-1113
DEALER: PO BOX 176
CHEHALIS WA 98532
Contractor's License WASHIHC0770A Expires 03/19/2002
INSTALLER: KEVIN ALLEN WAINS0075 8/1/2001 (800)241-5187
1951 N NATIONAL CHEHALIS WA 98532
REPRESENTATIVE: EDWIN BURNHAM
PO BOX 841
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: SKYLINE SETBACK:
VALUATION 56,150.00 YEAR: 2002
BANK HEIGHT:
LABOR & INDUSTRIES APPROVAL? SIZE: 27 X 56
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUBLIC
BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO
STORMWATER: YES NO
Exist: Exist: AREA Plat Conditions
Prop: 2 Prop: 2 Wetland Erosion
Total: 2 Total: 2 Seismic Streams
Flood Way Floodplain
Routing Date: (p F&W Landslide
�j� D2� I�(/ Shoreline Aquifer
Forest: Commercial Rural
Proximity_, ....,.----ii
— -
Type Amount Paid By: Date: Receipt: A
' tit)
Manufactured Homes "$141.00 MAM 01/30/02 43991 (�► �r
Potable Water Application $30.00 MAM 01/30/02 43991 E 200l
Total: $171.00
_, -;,4111 i• 1,1 .
SPECIAL CONDITIONS CASE # BLD02-00046
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on 1/30/02 for the potential presence of Environmentally Sensitive
Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an
initial Geographic Information Systems mapping review and an investigative site
inspection, the following ESAs were confirmed to be present on the subject property:
Susceptible Aquifer Recharge Area.
2.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological
formations that allow percolation of the surface water into the soils and the underlying
zone of saturation. Aquifers are geologic formations that contain sufficient saturated
permeable material to yield significant quantities of water to wells and springs. Aquifers
serve as the source of drinking water within most of the rural portions of Jefferson County.
3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
4.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water
quality degradation. The submitted proposal does not require additional aquifer
protection measures. However, during construction the project shall follow the Best
Management Practices (BMPs) and facility design standards as identified and defined in
the Stormwater Management Manual for the Puget Sound Basin (see attached).
5.) The applicant is proposing to create or add 1,550-square feet of impervious surface.
Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires that
your proposal submit adhere to Best Management Practices to control sedimentation and
erosion on the subject property.
6.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater,
erosion and sediment during construction. BMPs shall address permanent measures to
stabilize soil exposed during construction, and in the design and operation of stormwater
and drainage control systems.
7.) A REVISED site plan as submitted with the building application on 2/07/02 has been
reviewed for consistency under the UDC, and has been approved by Jefferson County
Department of Community Development. Any modifications, changes, and/or additions to
the stamped, approved site plan dated 2/12/02 shall be resubmitted for review and
approval by Jefferson County Department of Community Development.
8.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as the amount of
impervious surface which includes roof tops, gravel driveways, concrete, etc.
9.) Jacob Miller Road is classified as a Local Access Road and thus requires a minimum
20-foot front yard setback (measurement shall be taken from the property line). The
northern lot line shall also maintain a minimum 20-foot setback from the identified
easement. The additional side and rear setbacks are 20-feet.
10.) The building height is not to exceed 35 feet.
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JEFFERSON W COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST. PORT TONSEND WA 98368
MANUFACTURED HOME INSTALLATION PERMIT APPLICATION
Q NEW BUILDING 0 REPLACEMENT
SIZE 2_7 J` (-
YEAR '2_ v : z_
MAKE l< Y 1 hfi ., • P� /
COST L z7
BEDROOMS: BATHROOMS: JA N 3 3
EXISTING EXISTING L
PROPOSED ' PROPOSED DEPT. OF COM+�u
___ WPMENT
TOTAL L TOTAL
TYPE OF SEWAGE DISPOSAL: WATER SUPPLY:
❑ SEWER 0 COMMUNITY�� SYSTEM 0 PRIVATE WELL 0 TWO PARY WELL
❑ INDIVIDUAL SYSTEM [�'"COnventional CBLIC
PERMIT#SEP 0 Alternative Name of water system: P D id- /
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 r 6 -t+7 DATE �' �
NAME (PLEASE PRINT) rr, C, )' R 11•3/4 t r1-1
FOR OFFICE USE ONLY
CONSISTENCY REVIEW FEE 39.00 RECEIPT# `'fat
BASE FEE t4( . 90
ADDITIONAL SECTIONS 6 CASH/CK# t 2)*--
SUBTOTAL �Or�•OC� DATE 30/
2 Off/
POTABLE WATER 0
911/ROAD APPROACH
TOTAL 'U
H:HOME PLNCNTRUNFOBLDIFORMSIMOBILEAP.11/26/01
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