1992, 08-10 App for Certificate of Exemption,APPROVE
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APPLICATION FOR CERTIFICATE OF EXEMPTION'S
APPLICATION FEE ),1, 0 /* 9-9-0470 eggL APPLICATION NOS, -5fv G
1. Applicant'sNamc: John Toothaker Home Phone: 928-5363
Business Phone:
Adder; 1 1 1 1 5 E. Empire
City: Spokane State: Wa. Zip:99206
2. Legal description of property for which this "Certificate of Exemption" is being applied i
Section: //4 Township .-25 - N. Range 4'4' within Spokane County, Washington.
The Fast r1y one hatf Lnt 5, R1nr-k 4 Snnth
and the Northerly 115 feet o.f the Easterly
Westerly one half of Lot 5. Block 4. So��th
in clrandvi ew Ac'rps as rerordpd in Rook "R"
in Spnkane County, Wa
of the R_R_ R/W
32 feet of _h _
of the R_R'_ R/W.
, pagp 19 of Plats
3. Tax parcel number £ SDY3, 07/ b.4; /04. Property size: (sq. ft. or acres) _ 59 Ac-
S. Zoning: (//4 7. 5-. Comprehensive Plan category: t/4f3g� •
7. Intended use of property: 7sr C §
3. For all 3.3(b)(2) and 3.3(c)(d) exemptions, the Spokane Co ty Health District must complete the following:
A preliminary consultation has been ma iscuss the Certifi ate f Ec emption. The applicant has been
informed of applicable rcquirem d standards. U0 iJo
aturc
Date
9. 1, the undersigned, swear under penalty of perjury that the above responses are made truthfully and to the best
of my knowledge. I also agree to furnish any further documentation thaz may be required by the Subdivision
Administrator. I also understand •that, should there be any willful misrepresentation or willful lack of full
disclosure on my part, Spokane County may withdraw any approval that it might issue in Fdiance on this
applicad
If
Notary Publiin and for the f w •
r ashi n
Residing at s _t \Ate-9K c e)�0 ,1it�
My appointment expires c F5F)
r00 :4. L_I ti •d' ll
Date or' :� `1, ':
NOTARY SEMI ?p `S. ' 01'-:c., i
.,;tat;;,. �,
STAFF ONLY
THE SUBDIVISION ADMINISTRATOR FINDS THAT THIS "CERTIFICATE OF EXEMPTION" IS
APPROVED/DENIED FOR SAID PROPERTY DEe CRIBED ABOVE, PURSUANT TO SPOKANE
COUNTY SUBDIVISION(S) SECTION "3 •3
THIS CERTIFICATE OF EXEMPTION SHALL BE SUBS ECP TO THE FOLLOWING CONDITIONS
AND/OR FINDINGS:
1. The applicant shall comply with all requirements and regulations of the Spokane County Zoning Code.
The applicant shall comply with all requirements of the Spokane County Health District and/or Utilities
Department regarding wastewater disposal and on -site water or public water systems.
3. The applicant shall comply with the following additional conditions:
THIS CERTIFICATE OF EXEMPTION IS AHD SHALL RUN `VrrT T. T .NIT±, AND SHALL BE
AppL II A LE TO THE APPLICANT, OWNER, THEIR HEIRS, SUCCESSORS OR ASSIGNS.
/DENIED THIS /a DAY OP'
19 .
6'L( !>D�J
THIS CERTIFICATE MUST .ACCOMPANY YOUR BUILDING PERMIT APPLICATION
SPOKANE COUNTY PLANNING DEFT., 721 N. JEFF•ERSON, SPOKANE. WA 99260 (509)456-2205
CERTIFICATE OF EXEMPTION ISSUED BY SPOKANE COUNTY, WASH1*1GTON
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