Natural Resource Assessment/ Site Plan Technical Review Application
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1 Natural Resource Assessment/ Site Plan Technical Review Application Documents Required for Submittal: *NOTES: If a proposal is within the shoreline jurisdiction please use appropriate shoreline application form. Completed and signed Natural Resource Assessment/Site Plan Technical Review Application Site plan (provide detail and accurate information): 2 copies of site plan is required ((1) 24 x 36 and (1) 11 x 17 ) Dimensions of the property drawn to common scale (architectural, engineering) Location of any wetlands, creeks/streams, critical habitat areas, or geological hazards, if known Locations and dimensions of all existing and proposed structures on the site Locations and dimensions of all existing and proposed impervious surfaces on the site Stormwater plan (if applicable) Location of the Ordinary High Water Mark (if applicable) Distance of any structures to the Ordinary High Water Mark (OHWM) of any creeks, streams, rivers or lakes, (if applicable) Location and dimensions of all areas to be cleared, filled, or excavated Location of existing or proposed septic tank/drain field, and well or utility lines preliminary topographic drawings depicting the basic elevation features of your property Names and locations of all public or private roads Show access from the County Road to the building area include the driveway length and width North Arrow Scale Required fees per current Unified Fee Schedule. These may include, but are not limited to: Base Fees: - NR Assessment with NR Delineation fee - $ (UFS #8496) - NR Assessment without NR Delineation fee - $ (UFS #8497) Additional Technical Review Fees: - Mitigation Plan Review fee - $ (UFS #2771) - Flood Review fee - $ (UFS #2780) Property corners, road access point, and building corners MUST BE FLAGGED prior to staff site inspection (Otherwise additional site inspection fees will be assessed See current Unified Fee Schedule) Your feedback is important to us as we strive to improve our service to you. Please use this link 9/PDS-Customer-Survey-107 to complete a Customer Survey.
2 For Administration Use Natural Resource Assessment/ Site Plan Technical Review Application Permit#(s) Stamp Received by: Receipt #: Paid: Total Fees: Reviews: CA Wetland/HCA CA Geo Hazards Flood Watershed Fire Agent/Contact Name: Mailing Address: State Zip Code Phone # ( ) Fax # ( ) Property Owner Name Mailing Address: State Zip Code Phone # ( ) Fax # ( ) City City Property Information Site address Assessor s Parcel Number Parcel size: in acres/square footage (If less than an acre please provide square footage) Zoning: Watershed District: Lake Whatcom Lake Samish Lake Padden Birch Bay Drayton Harbor NPDES Phase II Other Natural Resource Assessment Submittal Checklist Page 2 of 5
3 Do you own any contiguous property, joining property or have control of joining property? If yes, please provide parcel numbers Proposed water source for development: No Water Source Required/Existing Service Well Water Association Water District Surface Water Rain Water Name of Water Purveyor (if applicable): Project Description Include description of all proposed work for this application: (include full project concept attach additional pages if needed) Select all that apply to this application from the following: Detached Structure Driveway Landscaping On Site Septic / Drainfield Parking Single Family Residence Well Property Physical Site Characteristics (Included on the Site Plan) Check all characteristics that apply on and within 300 feet of the entire parcel. Streams Ponds and lakes Forested areas Drainage ditches Steep slopes Brush / scrub Frequently flooded areas Landslide areas Pasture, lawn, landscaping Wetlands/seasonally wet/ Existing developed areas Wildlife features soggy areas Natural Resource Assessment Submittal Checklist Page 3 of 5
4 Fee Responsibility Venue and Jurisdiction: The parties hereto recognize and agree that the venue of any action involving their rights or obligations related to this application shall be in Whatcom County, and the parties rights and obligations hereunder shall be determined, in accordance with the laws of the State of Washington. Fee Guaranty: Notwithstanding that this application has been submitted in the name of a company, I personally guarantee payment of fees accrued according to the terms listed in the Whatcom County Unified Fee Schedule and that my personal guarantee is part of the consideration for review of the application. I/we,, hereby certify that the above statements and the information contained in any papers or plans submitted herewith are true and accurate to the best of my knowledge. Signature of Applicant Signature of Owner I certify that I know or have satisfactory evidence that is/are the person(s) who appeared before me, and said person(s) acknowledged it to be his/her free and voluntary act for the uses and purposes mentioned in this instrument. d Notary Signature: Printed Name: Notary Public in and for the State of Washington Residing at My appointment expires: / / Natural Resource Assessment Submittal Checklist Page 4 of 5
5 Agent Authorization If you are authorizing an agent to apply for permits on your behalf you must complete this form and have it notarized, which will provide authorization for a designated agent to apply for permits on your behalf. I/we,, the owner(s) of the subject property, understand that by completing this form I hereby authorize to act as my agent. I understand that said agent will be authorized to submit applications on my behalf, and that any fees associated with submitted applications are due to me and not to the said agent. I also understand that once an application has been submitted that all future correspondence will be directed to the agent. Property Address Parcel Number Property Owner Printed Name Property Owner Printed Name Property Owner Signature Property Owner Signature I certify that I know or have satisfactory evidence that is/are the person(s) who appeared before me, and said person(s) acknowledged it to be his/her free and voluntary act for the uses and purposes mentioned in this instrument. d Notary Public Signature Notary Public Printed Name Notary Public in and for the State of Washington Residing at My appointment expires: / / Natural Resource Assessment Submittal Checklist Page 5 of 5
Natural Resource Assessment Submittal Checklist
WHATCOM COUNTY Planning & Development Services 5280 Northwest Drive Bellingham, WA 98226-9097 360-778-5900, TTY 800-833-6384 360-778-5901 Fax Mark Personius, AICP Director Natural Resource Assessment Submittal
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*NOTE: As per SCC , Property owner is required to sign the application if the Agent does not have written proof of authorization.
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*NOTE: As per SCC , Property owner is required to sign the application if the Agent does not have written proof of authorization.
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