CUE-35-87
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RECQI/ED
NoV 2 3 i987
~l~ SPOKAIVE COUNTY ENGINEER
sPO~wE co«vr~r, was~unGron~
IN THE MATTER OF A CONDITIONAL USE ~
PERMIT TO ALLOW A MANUFACTURED )
HOME TO TEMPORARILY HOUSE A ) FlNDINC,S. CONCLUSIONS
DEpENDENT RELATIVE (CUE-35-87); ) AND DECISION
LESUE FOGELSON )
SUMMARY OF APPLICATION:
The applicant is the owner of approximately 2.5 acres of land, upon which he desires to
establish a seoond residence for his brother, Clifton O. Fogeison. Section 4.04.170(j)
of the Spokane County Zoning Ordinance requires a oonditional use permit to authorize
this situation. Authority to consider and grant such a request exists pursuant to Sections
4.03.010 19. G.. 4.24.010 and 4.24.560 of the Spokane County Zoning Ordinance.
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The properly is located in the Spokane Valley, north of Vaileyway and west of and
adjacent to Flora Road in the SE 1/4 of Section 13, Township 25, Range 44. The
Assessor's parcel number is a portion of 13544-0103. The properiy is addressed as
North 601 Flora Road.
DECIStON OF THE ZONING AQIUSTOR:
Based upon the evidence presented and circumstances associated with the project
proposal, the Zoning Adjustor APPROVES the oonditional use pernnit oondittoned and
stipulated as set forth below.
PuBUC
After examining all available information on file with the applfcation, the Zoning
Adjustor oonducted a pubiic hearing on November 17, 1987 rendered a verbal decision
on November 17, 1987 and a written declsion on November 20, 1987.
FINDINGS OF FACT
1 The proposal is generaliy located in the Spokane Valley, north of Valieyway and
west of and adjacent to Fbra Road in the SE 1/4 of Section 13, Township 25, Range 44,
and is further described as a ponion of Assessor's Parce! No. 13544-0103, being
more completely described in Zoning Adjuster File CUE-35•87.
2. The proposal oonsists of the appllcant's wishing to establishing a small, used
manufactured home, approximately 8 feet by 42 feet, on his property in the Spokane
Valiey for the purpose of housing his dependent brother. The manufactured home would
be located behind an existing bam facility, which presentiy has electric power to it. The
power wouid be run to the nearby manufactured home, while water would be brought
from the existing Public Water Supply System line presently serving the house and
irrigation spigots in the rear yard. Sanitary waste wouid be run toward Flora Road into
a faciiity presentiy used by the upstairs portion of the existing dwelling unit. The
existmg dwelling unit also has another sanitary waste disposal system for other portions
of the house. There would be no new driveway aocesses oonstructed.
3. The adopted Spokene County Future Land Use Plan designates the area of the
proposal as Suburban and the proposal is consistent with the County's entire
Comprehensive Plan, including the Future Land Use Pian.
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FILE: CUE-35-87 ZONING ADJUSTOR DECISION PAGE 2
4. The site is zoned Agricultural, which would allow the proposed use upon
approval of this application.
5. The existing land uses in the area of the proposal include small-acreage tract
residential and high•density residential at various scattered locations, all of which are
oompatible with the proposal.
6. Apparentiy the property is being dlvided into e two-bt shon subdhrision. In
that case, the right to estabiish a dependent relative would run with the land on the
parcel fronting on Flora Road, but would not be extended to the more easterly portion
created by the two•lot short subdivision.
7. The proposal is exempt from the provisions of Chapter 43.21 C RCW pursuant
to WAC197-11-800(1)(a), (b)(i) and Spokane Environmental Ordinance
11 .10. 070(l )(a).
8. The applicant has been made aware of the reoommendatwns of varbus
County/State agencies reviewing this project and has indjcated he can oomply with those
reoommendations.
9. The proposed site pian indicates that setbacks, parking, hefght of the
structure(s) will oonform to the Spokane County Zoning Ordinance.
10. The applicant(s) has/have indicated he/she understood: (a) the limitations
imposed under the terms of Section 424.560 of the Spokane County Zoning Ordinance;
(b) thai if the temporary residence is desired for more than one yesr the application
will have to be renewed; and (3) that a Title Notice will be flled by Spokane County with
the Auditors Office regarding temporary occupancy only be specific named parties.
11. The applicant has submitted the required form signed by a licensed physician
or its equivalent regarding the need for dependent care and sufficient need is found to
exist.
12. No one appeared to oppose the proposal nor were any written comments
adverse to the proposal received.
13. The proper legal requirements for advertising of the hearing before the Zoning
Adjustor of Spokane County have been met.
14. Any oondusion hereinafter stated which may be deemed a finding herein is
hereby adopted as such.
From the Findings, the Zoning Adjusior oomes to these:
COWAIJSKM
1. The proposal fs listed in the Spokane County Zoning Ordinance as s oonditional
use atlowed in the Agricultural zone and the proposal does meet the established and
applicable criteria described for that conditional use.
2. Various perfomtance standands and criteria are additionally needed to make the
use oompatible with other permitted activiUes in the same vicinity and zone and to
ensure against imposing excessive demands upon pubtiC utilities and these shail be
addressed es oondrtions of approval.
3. The proposal wilt not be detrimental to the Comprehensive Plan or the
surrounding propenies.
4. The Zoning Adjustor may require such oonditions of approval as necessary and
appropriate to make the project most compatible with the public interest and general
welfare.
5. Any finding hereinbefore stated which may be deemed a oonclusion herein is
adopted as such.
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~ FILE: CUE-35-87 ZONING ADJUSTOR DECtStON PAGE 3
DEClSlON
From the foregoing Findings and Conclusions, the Zoning Adjustor APPROVES the
proposai. The folloMng CONDITIONS OF APPROVAL ARE STIPULATED.
OONDffXMOF
I. GENERAL
1. The following conditions shall apply to the applicant,, owner and suocessors in
interest.
2. Failure to compiy with any of the oonditions of approval contained in ihis
dec.ision, except as may be relieved by the Zoning Adjustor, shall oonstitute a violation of
the Zoning Oniinance and be subject to such enfon;ement acdons as are appropriate.
3. This parcel shall not be further subdivided unless oonsistent with RCW 58.171
ihe varrous oounty subdivisions regulations and ihe Spokane Couniy Comprehensive Pian
for the area.
4. The Department of Building and Safety shall route the building permit
applicaUon to all of the agencies and offic:e of oouniy gavemment bebw which are
lndicated es needing to give their authorization prior to the release of s buiiding permit.
Upon reviewing the various plans retumed to the Department of Building and Safety by
the other departmenis, the department will consuit with the Planning Department if
there are any changes resuiting from review by the other departments when oompared to
the plans as approved by ihe Planning Department. Such review may necessarily result
in a revision of the site plan for use by the Department of Buiiding and Safety or
possibly a withholding of the building permit until eny oonflicts are resolved.
II. PLANNING OEPARTMENT
1. The manufactured home shall be; (a) a minimum of forty-two (42) feet or
more in length and be at least eight (8) feet in width; (b) oonstnicted in acoordance with
State of Washington or Federal manufactwred home oonstruCtion stsndards as evidenced
by the attachment of en insignfa; (c) designed for transportation after fabrtcation on
public streets and highways on its own chassis and wheels; (d) skirted wlth a fire
resistant material; (e) oonnected to electric power, water supply and sewage disposal
facitities and other utilities as approprfate or necessary; and (Q the unit shall not be
permanently affixed to the land, except for temporary oonnections to uUlties.
2. The manufactured home shall be occupted by either the dependent relative and
family, or by the relative with family providing care to the dependent relative owning
and oocupying the principal residence. The dependent relative is established as
Clifton O. Fogelson.
3. Upon temnination of the need for dependent relative care or ihe sale or lease of
the property, the appficant shall remove the manufactured home from the site within
forty•five (45) deys.
4. A statement (TiUe Notice) shall be reoorded by the Planning Department 1n the
County Auditor's Office stating that the manufactured home is temporsry and tor the use
of the named dependent relative(s) for wHich the Conditional Use Permit is approved and
that the manufactured home is not a permanent structure to be iransfened with the
property if It is sold or leased.
5. The temporary residence shall be "aocessory" onty to a pan:el or tract of land
under the ownership or lease by the appiicant for the Conditionai Use Permit.
6. Only one temporary residence may be permitted on a tot, pan;el or tract of land
under the ownership or lease by the applicant for the Conditiona! Use Permit.
7. The pernnit shall be granted for a period of one year and may be renewed
administratively by the Zoning Adjustor or hls/her designee upon the recertification:
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FILE: CUE-35•87 ZONING ADJUSTOR DECISI4N PAGE 4
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(a) by a licensed physician that the medical problem still exists; and (b) by the original
applicant that the need stiil exists.
8. The renewal period shail be the first day of the month oocurring after 12 entire
months pass since the date of this decision (December 1v 1988).
9. If the Zoning Adjustor believes there are extenuating circumstances associated
with the renewal of the permit, he/she may cause there to be a publtC hearing and
reconsideration of the permlt; the expense shail be that of the oounty's if such
reconsideration takes piace.
10. The manufactured home shall be located in sutstangal oonfortnance with the site
plan on file in the Planning Department and any modifiscation of proposed location shall
only be authorized by the Zoning Adjustor prior to location and erecdon at the site. The
approved site plan is indicated by "Approved Site Plan - TGM, 11/18J88'
11. If a two-Iot short subdiviswn is estabiished on the parcel, the dependent
relative privilege is establtshed only on the portion fronting on Flora Road.
III. DEPARTMENT OF BUILDING 8 SAFETY
1. The Department of Buildmg and Safety shall route the building permn
application to ail of the agencies and offioe of county govemment below which are
indicated as needing to give their authorization prior to the release of a building permit.
Upon reviewing the various plans returned to the Department of Building and Safety by
the other departments, the department wdl consuh with the Planning Department if
there are any changes resulting from review by the other departments when oompared to
the pians as approved by the Pianning Department. Such review may neoessarily result
in a revision of the site plan for use by the Depanment of Bufiding ard Safety or
possibly a withholding of the building pernnit until any oonflicts are resolved.
IV. tlTIUTIES DEPARTMENT
1. The owner(s) or sua;essor(s) in interest agree to suthorize the County to place
their name(s) on a petition for the formation of a UUD by petniOn method pursuant to
RCW 36.94, which petttion includes the owner's property and further not to object by
the signing of a protest petition against the formation of a ULID by resolution method
pursuant to RCW Chapter 36.94 which includes the owner's property. PROVIDED. this
condition shall not prohibit the owner(s) or successor(s) from objection to any
assessment(s) on the property as a resutt of improvements calied for in oonjunction
with the formation of a ULID by either petitron or resolution method under
RCW Chapter 36.94. N,QTE: Planning Depanment is processing this.
2. Pursuant to the Board of County Commissioners Resolution No. 80-0418, the
use of on-site sewer disposal systems is hereby authorized. This authorizafion is
conditioned on oompliance with all rules and regulations of the Spoketne County Health
District and is further oonditioned and subject to speciflc appiication approval and
issuance of permits by the Health Officer.
3. Any water servic;e for this project shall be provided in acoordance with the
Coordtnated Waier System Plen for Spokane County, as amended.
V. HEALTH DISTRICT
1. Sewage disposal shall be as authorized by the Oirector of Ugtities, Spokane
County.
2. Water service shall be ooordinated through the Director of Utilities, Spokane
County.
3. Water seniice shall be by an existing public water supply when approved by
the Regional Engineer (Spokane), State Department of Social and Health Servioes.
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FILE: CUE•35-87 ZONING ADJUSTOR DECISION PAGE 5
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4. Subject to specific application approval and issuance of permits by the Health
Officer, the use of an individual on-stte sewage system may be authorized.
5. Use of private welts and water systems 1s prohibited.
VI. ENGINEERING DEPARTMEIVT
1. None is applicable.
NOTICE: PENDING COMPLETiON OF Atl OONDITIONS OF APPROVAL WHICH IVEED TO BE
COMPLFTED PRtOR TO PERMR ISSUANCE, PERMITS CAN BE RELEASED PRIOR TO THE
LAPSE OF THE (10)•DAY APPEAL PERIOD. HOWEVER, THE COUNTY HAS NO UABILITY
FOR DCPENSES AND INCONVENIENCE INCURRED BY THE APPLJCANT IF THE PROJECT
APPROVAL IS OVERTURNED OR ALTERED UPON APPEAL
DATED this 20ih day of November, 1987.
Thomas G. er. AlCP
Zoning ster
Spokane County, Washington
FlLED:
1) ApPlicant
2) Parties of Reoord
3) Spokane Couniy Engineering Department ✓
4) Spokane County Health Distnct
5) Spokane County Utiliges Department
6) Spokane County Department of Building 8 Safety
7) Planning Department Cross-reference File andlor Electronic File
NOTE: ONLY THE APPUCoANT OR AN OPPONENT OF REOORD MAY FlLE AN APPEAL
WITHIN TEN (10) CALENDAR DAYS OF THE ABOVE DATE OF SIGNINt3. APPEAI. MUST 8E
ACCAMPANIED BY A$100.00 FEE APPEALS MAY BE FILFD AT THE SPOKANE COUNTY
PLANNING DEPARTMENT, BROADWAY CENTRE BUILDIN(3, NORTH 721 JEFFERSON
STREET, SPOKANE. WA 99260. (Sections 4.25.090 end 4.25.100 of the Spokane
Couniy Zoning Ordinance)
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OFFICE OF THE COUNTY ENGINEER
SPOKANE COUNTY, WASHINGTON
1 1--17-87
TQ : SPOF: ANE COt.1tVTY ZOhi Ih!G AnJ USTOR
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FFit]M: SF C1F ANE COUNTY ENG Z NEER
SUBJ n CUC-- ~'5-87 (FOrCLS(7hl )
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The CoLtnt y Englneer iny Depar t nient has r eva.eweci the above r~.~f c•renced
,lPFIl xCat Lan. The followtng comments are orferec1 for -Lnciusion in ti~p-
Findings and Order as "Conditions ot Approva1" at-faLtld the reyuest he
.~pproveJ.
1 a 1AaE HAVE REV I EWED THE ABOVE REFERENCED F FiOF'CIS!AL AND HAVE NCl CQMMF_hJTS
TO h1(al-f E(:OhICEFiNI NG THE AF'F'L I CAT IOiV . THE Ar F'I_ ICAhIT SHOIILP BF
ADv iSED THAT AN AF'FfiQACH F'EF'M S T MUST BE CIBTAi NED FRQM THE GDUh.lT`l
ENG I NFER F'RT QR TC] T!-11= tCQPdIS!TF:UCT T QN Q!= r1NY NEtsl DFi T UEk=dAY AF'F'FiQRCI-iFS„
TH IS MUST BE DDh.lE F fti I fJR TO THE RELEASE fJF ABU I L.D I taG !7'ERM 7 T
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. SPOICANE COUNTY ZONIN6 ADJUSTOR
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PUBLIC HEARtN6 RECE11/ED
~ oCT 2 81987,
~hww~ sMew• t~Y~t Mr~~
SPOKANE COUP!TY EX~IMU
AGENDA: Novembe r 17, 1987 NOTE: HEARING IS ON TUESDAY, NOT WEDNESDAY
TIME: As set forth below; hearing opens at 9:00 a.m.
PLACE: Spokane County Planning Department
Broadway Centre Bui1 di ng
N. 721 Jefferson Street
Spokane, WA 99260
APPLICATIONS MAY BE yEARO IN THE FOLLOWING ORDER, EXCEPT THAT ITEMS CARRIED OVER FROM
THE PREVIOUS HEARINGS WILL BE HEARD FIRST. LEGAL DESCRIPTIONS AiVD PROJECT DETAILS
FOR TIIESE PROJECTS ARE AVAILABIE IN THE PLANNING DEPARTMEyT FILES.
APPEALS OF ANY OF THE DECISIOyS ON THE 3EL0W LISTED CASES MAY OyLY a~ FILED 6Y THE
APPLICANT OR AN OPPONENT OF RECORD ACCOMPANIED QY A$100.00 FEE. (Sections 4.25.090
and 4.25.100 of the Spokane County Zoni ng Ordi nance
A Determination of Non-Significance (DNS) has been issued FOR EACIi PROPOSAL marked with
an A ONS is a decision, based upon information available at the time the DNS was
issued, that no Envtronmental Impact Statement has been ordered to be prepared because
it was judged that there was not likely to be a significant adverse impact to the
physi cal envi ronment. Wri tten comments regardi ng the DNS :(1) are due by the cl ose of
business hours, November 13, 1987; (2) should reference the specific file number; and
(3) should be addressed to the Spokane County Planning Department, North 721 Jefferson
Street, Spokane, WA 99260. Additionally, comments on the DNS and any other environ-
mental documents may be made at the public hearing, the time and p]ace of which is set
forth herein. Contact the Planning Department Staff for more information (509)456-2205.
1) CUE-35-87 CONDITIONAL USE PERMIT T~0 HOUSE A DEPENDENT
(This item will be heard at 9:00 RELATIVE
a.m. or as soon thereafter as Generally located in Spokane Valley, north of
possible) Valleyway and west of and adjacent to Flora Rd.
in the SE 1/4 of Section 13, Township 25,
Range 44.
PROPOSAL: The applicant requests a conditional use permit to allow the temporary
location of a manufactured home for Clifton 0. Fogelson, a dependent relative, on the
subject prope rty. Sections 4.04.170 jj and 4.24.560 of the Spokane County Zoning
Ordinan ce allow such a use upon issuance of a conditional use permit.
EXISTING ZONING. Agricultural
SITE SIZc: Approximately 2.5 acres
APPLICANT: Lesl ie Fogelson
N. 601 Flora Road
Veradale, WA 99037
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SpOKANE COUNTIf PLANNING DEPARTMEN?
APPL ICATIONS BEFORE THE ZON ING ADJUSTORIBOARD OF ADJUSTMENT,
Ce rti fi cate of Exenpti on Appl i catl on #3,.5- ' X )7
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Name of Appl i cant:
Street Address : Z.,R ~ U) r~~ Mome :
Ci ty: State: b Z{p Code: ClqDPhone:Work 4 L~~~-3b5r3
, Agent:
Nan~e of P rope rty Owne r(s ):~,,,~,,z < ' 7GL. t1 t
REQUESTED ACT ION ( 5) ( Ci r,s1.e-App rop ri ate Acti on
y a,ri an ce ( s) <tion di ti on al Us e Pe rmi t-.--, Non-Con fo rmi n g Lot/Use
wai ver of Yiol ation Temporary Use/Strvcture Other:
tttt,~*~t#~~tt*~*f*t***~~*~**~tt~~*##~#~#~~*
* FOR S7AFF USE ONLY *
*Ci te 0 rdi n an ce Secti on : ~ s y~lo 0 O1 d Code : L,~ New Code ~ t
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*Se ct i orl Towns hi p d~ Ran ge P rope rty Size LaCA-A
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*Exi s ti n g Zon i n g: 4LI;tl F. L. U. P. Oesi gn ati on :
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*PSSA: Y N UTA: Y N ASAI-~Y N FIRE DIST.:;9~/ LEGAL CHECKED 8Y: _
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*Hearing Date: Staff taking itt Applicatiorl:
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Existing Use of Property,: J s ~ce.,
n ci el _
, Describe Intended Proposal :_~i~ --~i ~ nQA- P m n orc.c. r4_
as rn o bojn e -6.y d ~ n~ ~ ~r,
relve_. .
Street Addness of Propertys Ue rn~_~
Legal Descri ption of Property ( Incl ude easemerit If appl i cable) :
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Parcei _5 4- D i D 3 PT Source of Legal Ta.~+&-+e
Total amount of adjoining land controlled by thts owner/sponsor: U
What i citerest do you hol d in the prope rty; -
Please list previous Planning Department actions involving this property: ~
LP rA- I Q r 5 r~- -
f~~~1r'A, C-RaFR THF PCNALTY OF PERJURY, THAT: (1) I AM THE OWNER OF RECORO OR AUTHORI-
ZED h.GENI FUR rHE NROPOSEO SITE; (2) IF NOT THE OWNER, WRITTEN PERh1ISSION FROM SAID
OWIVER AUl'HORIZ1NG MY ACTIONS ON HISIHER BEHALF IS ATTACHED; ANO (3) ALL OF THE ABOVE
RESPONSES AtiO TNOSE ON SUPPORTING DOCUMENTS ARE MADE TRUTNFULLY ANO TO THE 6EST OF
MY KNOWLEDGF.
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Addi ess :
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Phone No. : ate: )2-7
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NCT.,;aY .,EA~..- - Notary:
Date :
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A. BURDEN OF PROOF
It is necessary for the applicant or his/her representative to establlsh the
reasons why the requested proposal should be approved and to literally put fo rth
the basic case. Accordingly, you should have been given a fo na for your requested
action (variance, conditional use, etc.) designed to help you present your case
i n a way whi ch addresses the cri teri a whi ch the Zoni ng Adjustor must cons i der.
P1 ease fi 11 the form out and return i t wi th your appl i cati on . If you di dn' t get a
form, ask the Planning Oepartment pe rsonnel for advice on how to proceed.
6. SiGN-OFF BY COUNTY DEPARTMENTS
1. COUNTY HEALTH OISTRICT
a) Proposed method of water supply: uka-i
bl Proposed method of sewage dis osal: ~
. ~ L.I. ANk-
A preliminary consultation has een held to discuss the proposal. he appli-
a t has bplm o '4aed of requi reme ts and standards. ~
ure cQi ( D te Si gn- Waive
. COUNTY ENGINEER'S OEPARTMEN?
A prellminary consultation has been held to discuss the proposal. The appli-
cant has been informed of requirements and standards. (~~q
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Date
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~ COUNTY UTILITIES OEPARTMENT (Waive if outside WMAB)
j~ A preliminary consultation has been held to discuss the proposal. The
applicant has e informed of requirements and standards. -
. ?6aignature) te) (Sign-off Waived)
A4 The applicant is required to discuss the proposal with
to become informed of sewage disposal requirements
and standards.
[✓f The applicant is required to discuss the proposal with *fvl~
to become informed of water system requirements and
standards.
. WATER PURVEYOR (Waive i f outs i de CwSSA) NAME :~,-~aA
a) The proposal is/43m= located within the boundary of our future service
area.
b) The proposal is/ ~ located within the boundary of our current district.
c) We are/ ab'le to serve this site with adequate water.
d) Sa s act arrangements ~/have not been made to serve this proposal.
9 -2g-$7
S~gnature ` Date) (Sign-off Waived)
5. SEWERAGE PURYEYOR NAME: A) N
(If other than Spokane County)
A preliminary consultation has been held to discuss thp proposal. The
applicant has been informed of requirements and sta ar .
(.Si gnaturP l LDate ) S g off ai ved)
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° STATEMENT OF
- ATTENOING PNYSICIAN FOR DEPENDENT RELATIYE
, yPOwwMC tOUhtr COYNT wOYSi
7o a ss1 st 1 n meeti ng the requi rements of the Spokane County Zoni ng
Ordlnance. Section 4.24.560 M. and 4.03.020 19 G. concerning a licensed
physician's statement regarding the nature of the medical problem and the
definiton of "Dependent". I submit the following infonnation.
1) Ful t name of person(s) for Mhi ch i nformation i s gi ven Delow:
~ F r) .
2) Describe the nature of the medical or health related tircumstance(s),
physi cal and/or medl cal whi ch establ i sh a"dependency" si tuati on :
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3) Is thi s a ci rrumstance of short o 1 on9~ -~ern durati on:
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4) The Spokane County Zoning Ordinance defines a"dependentp rela as a
relative who has been determined by a 1lcensed physician to b ' y
or mental ly 1 ncapabl e of cari ng for themsel ves and/or thei r prop .
you believe your patient is so qualifled at the present time?
4--
Yes No
(Vhysfci an+ sRame ) CMARIES W. RANCE, M D
ALLENMORE MEOICAL CENrER STE A211
TACOMA, WA 98405
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STATEMENT OF
ATTENDING PNYSICIAN FOR OEPENOENT RELATIYE
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s►OKwNC COYMTr iOY'kT NOUit ~
To assi st i n aieeti ng the requi reaients of the Spokane County Zon1 ng
Ordinance. Section 4.24.560 b.2. and 4.03.020 19 G. concerning a licensed
physlcian's statement regarding the nature of the medlcal problem and the
defi ni tqn of "Oependent". I submi t the fol l owi ng 1 nformati on.
1) Ful l name of person(s) for which i nformation i s given below:
2) Oescribe the nature of the medical or health related circumstaace(s),
physical and/or medical which establish a"dependency" situation:
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3) Is this a cimumstance of short or long term duration:
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4) The Spokane County Zoning Ordinance defines a'dependent" relative as a
relative who has been determined by a lfcensed physician to be physically
or mentally incapable of caring for themselves and/or their property. Do
you believe your patient is so qualified at the present time?
,
V Yes No
John R. Macdonough, M.O.
B6007~ATlenmore+ Center)
Tacoma WA 98a05
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~ AFFIDAVIT OF
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DEPENDENT RELATIYE CIRCUMSTANCES
• • (THIS STATEMENT MUST 6E N07ARIZED)
gPG"ftC CO~"♦ Gc44f «OLSL
STATE OF WASNINGTON ~
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COUNTY OF SPOKEINE ~
, being duly sworn on oath deposes and says:
pp1icant-
1) I am the owner, leasee or contract purchaser of the following property:
Assessors Parcel L_z5_,,r4L4- o/ O,-3
Legal Description: as
(continue separate sheet)
2) I seek to house '
fu name s o depen ent e at ve s
by addition of a separate manufactured home on the property in addition to
the existing permanent residence, all under the provisions of the Spokane
County Zoning Ordinance, Section 4.24.560.
3) The above named person(s) are related to me as follow:
ay The above named relatives are dependent upon me because of the following
circumstance,s:
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5) In your opinion, 1s (are) the above person(s) physically or mentally in-
capable of cartng for themselves and/or their property? j/ Yes No
6) I fully understand I am responsfble for the removal of the manufactured
home and related improvements at such time as the conditional use permit
becomes invalid or the above named dependent relative(s) no longer need
dependent care.
.
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PrthW~ype ame gnature
SU6SCRI8E0 and sworn before me thi s,-PlWday of 19
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