HomeMy WebLinkAboutBLD2003-00284 i
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#: BLD03-00284 Received Date: 5/5/2003
SITE ADDRESS: 720 NO NAME RD Issue Date: 12/29/2003
PORT LUDLOW, 98365
APPLICANT: LARRY L HESS
CAROLYN R COLLETT
PO BOX 951
CHIMACUM WA 98325
SUBDIVISION: Block: Lot: T 12
PARCEL#: 821063013 Section: 6 Township: 28 N Range: 01 E
CONTRACTOR/
DEALER
INSTALLER: JAIME KOZELISKI WAINS0626 Expires: 7/31/2004
1112 JACOB MILLER RD PORT TOWNSED WA 98368
PROJECT DESCRIPTION: RELOCATE MOBILE HOME
MAKE:
YEAR:
SIZE:
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 12/29/2004.
REQUIRED INSPECTIONS:
[ ] Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED):
[ ] Blocking/Plumbing: �" an-s L/N��c. s,Toay aelt.[Y&ri 1—re—n,i0m5 OK 40-,/
[ ] Zoning Approval:
[ ] Septic System Approval: �//
[ ] Final/Skirting/Vents/Porches/Steps: 5Kii i'. a 0,0c ak
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
•
SPECIAL CONDITIONS CASE # BLD03-00284 •
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on May 19, 2003 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:
Seismic Hazard, Wetlands.
2.) Development Review staff conducted a site visit of the parcel May 28, 2003 and verified
wetlands exist on the parcel. A letter dated July 2, 2003 from Olympic Wetland
Resources determined a high quality peat bog exists on site and the pond located to the
north of the peat bog is consistent with characteristics of a man-made pond.
3.) The Administrator determined the applicant may temporarily site the mobile home
(BLD03-00284) in the location proposed within the wetland buffer during construction of
the single family residence. All evidence of the mobile and transport line (SEP03-00146)
shall be removed prior to completion of the single family residence proposed under
BLD03-00698.
4.) Buffers are areas that shall be maintained in their natural condition, however, minor
pruning or alteration of vegetation may be permitted as long as the function and character
of the buffer are not diminished.
5.) Among the native conifer species which may be used in buffers or for re-vegetation
include, but are not limited to: Grand Fir(Aibes grandis), Sitka Spruce (Picea Sitchensis),
Shore Pine (Pinus Contorta), Douglas Fir(Pseudotsuga Menziesii), Western Red Cedar
(Thuja Plicata), and Western Hemlock(Tsuga Heterophylla).
Among native tree species which may be used includes: Vine Maple (Acer Circinatum),
Big-Leaf Maple (Acer Macrophyllum), Red Alder(Alnus Rubra), Pacific Madrone (Arbutus
Menziesii), Quaking Aspen (Populus Tremula), Black Cottonwood (Populus Trichocarpa),
Bitter Cherry (Prunus Emarginata), Oregon White Oak(Quercus Garryana), Cascara
(Rhamnus Purshiana), Pacific Willow(Saliz Lasiandra), and Scouler's Willow(Saliz
Scouleriana).
Among the native shrub species which may be used are: Sevice-Berry (Amalanchier
Alnifolia), Red Osier Dogwood (Cornus Stolonifera) Sala! (Gaultheria Shallon), Ocean
Spray (Holodiscus Discolor), Indian Plum (Oemlaria Cerasiformis), Pacific Ninebark
(Physocarpus Capitus), Red Flowering Currant(Ribes Sanguineum), Wild Rose (Rosa
Nutkana), Swamp Rose (Rosa Pisocarpa), Willows (Salix ssp.), Red Elderberry
(Sambucus Racemosa), Snowberry (Symphoricarpos Albus), Evergreen Huckleberry
(Vaccinium Ovatum), Red Huckleberry (Vaccinium Parvifolium).
6.) A wetland buffer of 150 feet is required for a Category I wetland. The wetland has not
been delineated and requires a 225 foot setback for a waiver from the delineation. The
Administrator has determined the applicant may place the proposed single family
residence in the location of the existing mobile home and temporarily site the mobile home
and transport line within the buffer during construction. The maximum buffer possible
shall be preserved and shall include all existing vegetation located between the proposed
mobile home and wetland.
7.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or
every one hundred (100) feet, whichever is less. Signs shall contain the following
statement: "Wetland & Buffer- Do Not Remove or Alter Existing Vegetation."
8.) A permanent physical separation along the upland boundary of the wetland buffer area
shall be installed and permanently maintained. Such separation can include installing
logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC
Administrator.
9.) All construction activities shall not encroach upon the buffer. This includes the storage or
preparation of materials.
10.) The applicant shall remove the mobile home and the transport line located within the
wetland buffer prior to final Certificate of Occupancy for the single family residence
proposed under BLD03-00698.
•
11.) The area within the wetland buffer temporarily utilized for siting of the mobile home and
transport line shall be returned to the condition of the site prior to temporary siting of
structures.
12.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type,
geologic material, and groundwater that may combine to create problems with slope
stability, erosion, and water quality during and after construction or during natural events
such as earthquakes or severe rainstorms.
13.) The applicant is proposing to create or add 3,880 square feet of impervious surface and
7,680 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson
County Unified Development Code requires that your proposal submit a stormwater plan
meeting Minimum Requirements#1 -#5 of the Department of Ecology Stormwater
Management Manual for Western Washington.
14.) A Stormwater Plan has been submitted and approved by the Department of Community
Development. Once the subject permit has been issued the applicant shall fully
implement the provisions of the submitted plan and contact the Jefferson County
Department of Community Development to arrange a schedule to inspect the property for
plan compliance. A Certificate of Occupancy will not be issued until the Department
verifies plan compliance. No clearing for roadways or utilities shall occur on the project
site until clearing necessary for the installation of temporary sedimentation and erosion
control measures have been completed.
15.) Jefferson County determined that this proposal is categorically exempt from review under
the State Environmental Policy Act(SEPA) pursuant to WAC 197-11-800(1)(b)(i).
16.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
17.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on any lot less
than one-half acre unless totally screened from view of neighboring dwellings and
rights-of-way. Such screening shall meet all applicable performance and development
standards specific to the district in which the storage is kept, and shall be in keeping with
the character of the area. Screening shall meet the requirements of Unified Development
Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable
vehicles is prohibited except in those districts where specified as an automobile wrecking
yard or junk(or salvage) yard and allowed as a Permitted Use in Table 3-1 of the UDC,
and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any
such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area
(ESA).
18.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
19.) The building height is not to exceed 35 feet.
20.) Minimum setback from the edge of the easement for No Name Rd is 20 feet. Minimum
setback from the easement located along the northern parcel boundary is 20 feet(or 50
feet from the parcel boundary). Minimum setback from southern and eastern parcel
boundaries is 5 feet. Wetland buffers further affect setbacks.
21.) A minimum of two (2) onsite parking spaces are required for the single family residence.
Because the onsite relocation of the mobile home is temporary, no additional parking is
required.
22.) This parcel is a legal nonconforming parcel designated Rural Residential 1:10 under the
Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998.
23.) This parcel was created through a survey April 6, 1978 recorded under AFN 249009 with
the Jefferson County Auditor.
24.) No Name Rd is a private road identified as P119. A road approach permit is not required,
and an address of 720 No Name Rd has been assigned to the parcel.
25.) Potable water is provided by an onsite well.
26.) A septic permit(SEP80-00177)was finaled December 16, 1980 for a system with capacity
of 240 gallons per day. A temporary transport line was reviewed under SEP03-00146.
27.) A title elimination (BLD80-00012)was completed February 7, 1994 for the mobile home.
28.) The site plan as submitted with the building application on November 10, 2003 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 November 19, 2003 shall be resubmitted for review
and approval by Jefferson County Department of Community Development.
! I
29.) This approval is for temporary siting of a mobile home only. Any future permits on this site
are subject to review for consistency with applicable codes and ordinances and does not
preclude review and conditions which may be placed on future permits.
4
PERMIT # OLD
ON Lino km i, WL � diI �
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jrikk JEFFERSON COUNTY 2 8 4 ' '_ L.I
NOV i0 2oa3R
DEPARTMENT OF COMMUNThiti VELOPMENT:gr I t"
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„ , 621 Sheridan Street• Port Townsend•Washington 98368 �.a.!
360/379-4450 •360/379-4451 Fax _J 4 k I Y
http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
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Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the
applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a
separate stormwater site plan map.
Project Overview
1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the
site map.
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
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3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
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4. Describe the existing soils. Indicate soil type on the site map.
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5. Describe the existing site hydrology(i.e.,drainage;behavior of water on the site—above,below,and on the ground). Indicate
existing stormwater drainage to and from the site on the site map. Depid separate drainage basins on the site map, if
applicable,and indicate acreage of each.
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6. Describe any excess levels of noise generated by the proposed use or acti ' S7 oR M wA ED
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7. Describe si ifis geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams,
steep sloped. etc) the site. Indicate location on the site map.
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8. Describe the general vicinity of the site,including adjacent land uses and structures,utilities,roads,and sensitive/critical areas
(streams,wetlands,lakes,steep slopes,etc.).
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Permanent Stormwater Control Plan
This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs
and facilities to remain in place after construction of the project is completed.
"Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e.,per BMP T5.30
in the Manual)or,if not,what types of stormwater flow control will be utilized for the site or specific threshold discharge areas
within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities.
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10. If the project requires the use of stormwater treatment facilities,describe the types of stormwater treatment facilities proposed
for use on the site. Locate these facilities dlrt'the site plan and differentiate proposed facilities from existing facilities. [This is
normally for large"projects or projects that involve the potential for dispersion of contaminants.]
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11. Describe the performance goals and standards applicable to the project.
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12. Describe the flow control system. uara„�
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13. Describe the water quality system. u e
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14. Describe the conveyance system analysis and design. ;' }
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15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
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16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
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17. Describe the proposed surfacing material.
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18. Describe methods for restoration of the site.
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19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for
large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals
here.
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20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
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21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include
conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or
restrictions here.
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CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP)
The ConsjapicaZypIT addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the
template that f011aws must be installed on the ground during all construction phases of the project. The proponent is responsible for
preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater
Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential
development.
SECTION I—CONSTRUCTION SWPPP NARRATIVE
1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or
will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable
to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page
2-15).
12 Required Elements—Construction SWPPP
1. Mark Clearing Limits.
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2. Establish Construction Access.
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3. Control Flow Rates.
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4. Install Sediment Controls.
5. Stabilize Soils.
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6. Protect Slopes.
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7. Protect Drain Inlets. i ;ii 1
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12 Required Elements—Construction SWPPP(continued) ' HD) 16 v„ lc: ``_ r
8. Stabilize Channels and Outlets. a T
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9. Control Pollutants. WEPT, nF C3.1 s,ii`t`LEvELUPViti4r
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
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11. Maintain Best Management Practices(BMPs).
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12. Manage the Project.
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas,roads).
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b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
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3. Environmentally Sensitive Areas.
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a. Description of environmentally sensitive areas that are on or adjacent to the site.
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stormwater site plan template—rev.10/1/2003 9
JEFFERSON COUNTY DCE
b. Description of special requirements for working in or near environmentally sensitive areas.
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4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure).
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5. Construction Phasing.
a. Construction sequence
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b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule.
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II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
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b. Proposed wet season construction activities for environmentally sensitive areas.
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7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
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b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
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8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps. , —
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b. Diversions. ^� i�-�` ,-- _._._._..
c. Waterways. I d if!
d. Runoff/Stormwater Detention Calculations ly 1 0 2oo3 i
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SECTION II—EROSION AND SEDIMENT CONTROL PLAN 1 � 4 F I
Sediment and erosion control measures may be depicted on the master land use application I --
Pi p t 3 , a stormwater site plan,ars or ?
separate Construction SWPPP site plan. This is a checklist to ensure that the following are d c`elOn a la
1. General.
I�bW '10 2003
a. Vicinity Map _
b. Jefferson County Approval Block J ! A r
FPT. OF COMM; !r t'CE1lEiCPMEPi
c. Erosion and Sediment Control Notes � ----P-•-----------_.
2. Site Plan.
a. Legal description of subject property.
b. North arrow.
c. Indicate boundaries of existing vegetation(e.g.,tree lines,pasture areas,etc.).
d. Identify and label areas of potential erosion problems.
e. Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable).
f. Show existing and proposed contours.
g. Indicate drainage basins and direction of flow for individual drainage areas.
h. Label final grade contours and identify developed condition drainage basins.
i. Delineate areas that are to be cleared and graded.
j. Show all cut and fill slopes indicating top and bottom of slope catch lines.
3. Conveyance Systems.
a. Designate locations for swales,interceptor trenches,or ditches.
b. Show all temporary and permanent drainage pipes,ditches,or cut-off trenches required for erosion&sediment control.
c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts.
d. Shows grades,dimensions,and direction of flow in all ditches,swales,culverts and pipes.
e. Provide details for bypassing off-site runoff around disturbed areas.
f. Indicate locations and outlets of any dewatering systems.
4. Location of Detention Best Management Practices(BMPs). Identify location of detention BMPs.
5. Erosion and Sediment Control Facilities.
a. Show the locations of sediment trap(s),pond(s),pipes and structures.
b. Dimension pond berm widths and inside and outside pond slopes.
c. Indicate the trap/pond storage required and the depth,length,and width dimensions.
d. Provide typical section views through pond and outlet structure.
e. Provide typical details of gravel cone and standpipe,and/or other filtering devices.
f. Detail stabilization techniques for outlet inlet.
g. Detail controVrestrictor device location and details.
h. Specify mulch and/or recommended cover of berms and slopes.
i. Provide rock specifications and detail for rock check dam(s),if applicable.
j. Specify spacing for rock check dams as required.
k. Provide front and side sections of typical rock check dams.
I. Indicate the locations and provide details and specifications for silt fabric.
m. Locate the construction entrance and provide a detail.
6. Detad Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained and
illustra ed with detailed drawings.
7 N Cyr Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other than
sediment(e.g.,concrete wash water).
8. Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for monitoring water quality on
the construction site. Sampling-stations should be located upstream and downstream of the project site.
PERM' # OLD
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JEFFERSON COUNTY OCR
Stormwater Site Plan Changes
If the designer wishes to Flap changes or revisions to the originally approved Stormwater Site Plan,the proposed revisions shall be
submitted to DCD prior tO construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems,treatment facilities,flow control facilities,or structural source control BMPs
(not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as
constructed.
APPLICANT SIGNATURE
By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of the affected property.
/ A3
WN AUTHORIZED REPRESENTATIVE SIGNATURE) (DA
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
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stem-water site plan template—rev.10/12003
• 10 MLA03-00247
Review Type:I
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD03-00284 Received Date: 5/5/2003
SITE ADDRESS: 720 NO NAME RD
PORT LUDLOW, 98365
APPLICANT: LARRY L HESS PHONE: (360)732-6818
CAROLYN R COLLETT
720 NO NAME RD
CHIMACUM WA 98325
SUBDIVISION: Block: Lot: T 12
PARCEL NUMBER: 821063013 Section: 6 Township: 28 N Range: 01 E
CONTRACTOR/
DEALER:
INSTALLER: JAIME KOZELISKI WAINS0626 7/31/2004 (360)385-3215
1112 JACOB MILLER RD PORT TOWNSED WA 98368
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION: RELOCATE MOBILE HOME
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: SETBACK:
VALUATION YEAR:
LABOR & INDUSTRIES APPROVAL?
SIZE: BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO
Exist: 2 Exist: 1 STORMWATER: YES NO
Prop: Prop: AREA Plat Conditions
Total: 2 Total: 1 Wetland Erosion
Seismic Streams
Flood Way Floodplain
Routing Date: Cl (022 ��� F&W Landslide
Shoreline Aquifer
Type Amount Paid By: Date: Receipt: A ''
Manufactured Homes $151.00 MAM 05/05/03 56089
Potable Water Application $51.00 MAM 05/05/03 56089 DEC 2 9 2003
Total: $202.00 Jefferson County P1arunf ;
COUP
& Building Depertniv ce
411
JEFFERSON COUNTY CO.NITY DEVELOPMENT 621 SHERIDAN ST, PORT TOWNSEND WA 98368 '
MANUFACTURED HOME INSTALLATION PERMIT APPLICATION
0 NEW BUILDING 0 REPLACEMENT —D EC C EE I lt s)
SIZE / (-I ,4. 6, ea 11U1
I
YEAR l g _/ - MAY 5 2003 U
MAKE 4 LE am /17(0 liti. J[FFERSON COUNTY
COST DEPT.OF COMMUNITY DEVELOPMENT
BEDROOMS: BATHROOMS:
EXISTING 2— EXISTING
PROPOSED PROPOSED
TOTAL �-Z— TOTAL /
TYPE OF SEWAGE DISPOSAL: WATER SUPPLY:
❑ SEWER 0 COMMUNITY SYSTEM PRIVATE WELL 0 TWO PARY WELL
❑ INDIVIDUAL SYSTEM f"* 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 DATE .���0-3
NAME(P-LEASE PRINT) Z R1201' L— N
FOR OFFICE USE ONLY
CONSISTENCY REVIEW FEE _47.00 RECEIPT# 0° 8.9
BASE FEE 1S(• a°
ADDITIONAL SECTIONS CASH/CK# SD GC°
SUBTOTAL I l gi C DATE C/ C_/ 03
POTABLE WATER . .2--^�
911/ROAD APPROACH .. v 1-1 Irl
TOTAL ' ` oR i 00
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Designed and grafted by' O rn ti y PROJECT,. HESS FAMILY HOME
LARRY L. HESS
O .� " c, t TOB SITE ONLY/ (no mail to this address)
PO Box 951 C - . ,_ # LARRY L. 4 CAROLYN HESS
rb 720 NO NAME RD„PT.LUDLOW, WA
CHIMACUM, WA 98325 F= 360-732-6818 HM 206-679-5159 CELL
360-732-6818HM 206-679-5159 CELL - ; PARCEL NO. 821063013