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1988, 01-11 Permit App 87003953 MHSPOKANE COUNTY DEPARTMENT OF BUILDING AND SAFETY NORTH 811 JEFFERSON SPOKANE, WASHINGTON 99260 (509) 456-3675 I certify that I have examined this permit and state that the information contained in it and submitted by me or my agent to compile said permit is true and correct. In addition, I have read and understand the INSPECTION REQUIREMENTS/NOTICE provisions included herein and agree to comply with same. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. I understand that the issuance of this permit and any subsequent inspection approvals or Certificates of Occupancy shall not be construed to give authority to violate or cancel the provisions of any state or local law regulating construction, or as a warranty of conformance with the provisions of any state or local laws regulating construction. SIGNATURE OF Alt APPLICATION OWNER OR AGENT DATE APPLICATION it ..* * •* ki}j* ?1l* * J•-...i!.• y....:APPLICATION " t„* * ;:* * {* r:r(::x{ap*:::!::: SITE S , l . E , == 601 .1 r `t FLORA I't: .j i �:: !•i I•'-`. {.. e.:. L..'i::::: ..;i •{� >1.'-. t::! 0 :»� =r. 3 DDREa >:. VERADALE ICJ( 99037 PERMIT; C, S E:::::: SINGLE WIDE MOBILE FOR DEPENDENT RELATIVE I''I.....r::'•_: 002756 PI...ilI NAME= Vi:.:E' B ... I_' . I;; :::: 1.•. (::I ..r :::: ZONEZONE= A GT I" .:1: T) :I:: > T;::::: I::' (]F'tF:::(t=: 000000(]: is /A=_= r`-1 W:I:D..(.1"I== DEPTH:::: R/W:- 60 OF dtl._d1!.Yo: = 4 4 DWI::.I...L NGS = OWNER:::: I::'(:T(YEI_::(its, I.-I::SL E:: fA]T?k?Ei:E::.a =- 'vi::: E;nD(l._1:= W(] 99037 1-= H O N E:: -: CONTACT NAM::=: OWNER PHONE N'.JMBIER= BUILDING SETBACKS: F 1 l OI'\ I ' ... I... I:: _I .... 71 R.I. I:: l'-I T :::: . * ).. ,r n. n ! fi J. n. P. .F. -it :! !. S,. !t ]a.x..p..y,::n::n.-,� at ....:::..::. .. ..... .t . S )4 ! I t i::.1,' -F. i. 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S'/�- CC ************************************************************************* * INFORMATION WORKSHEET * ************************************************************************* * iO3 * * * * * LOT AREA:Slit) F/A: Q WIDTH: DEPTH: R/W:4 D * * * * * * PARCEL NUMBER: * STREET ADDRESS: * CITY/STATE/ZIP: * * SUBDIVISION: /v. 60/ / /kD O'eR O/R E, 94o3 7 * BLOCK: LOT: ZONE: AGRI DISTRICT: # OF BUILDINGS: 11 # OF DWELLINGS: �. * MAILING ADDRESS: A) (p C / //,Q j Al , PHONE: * CITY/STATE/ZIP: (JeaQ ,2!)/9,_/.7-7 G// 6/90 3 7 * CONTACT: PHONE: * * SETBACKS - FRONT: LEFT:. RIGHT: REAR: • PERMIT USE: X 5/ 2 ///a/ 4 c 7/G! r e d //!9c ae/J(ie /i / ************************************************************************* * BUILDING INFORMATION * * * * * CONTRACTOR LICENSE NO_: * * * CONTRACTOR: PHONE: - - * * MAILING ADDRESS: * * * ARCHITECT/ENGINEER: PHONE: - - * * * * * * MAILING ADDRESS: * * * * NEW: REMODEL: ADDITION: CHANGE OF USE: * * * DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES: * * * BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT. * * *REGUIRED PARKING: HANDICAP: SEWER: (Y/N) : HYDRANT: ************************************************************************* • * PLuyeIf\C I+\FCRMATION * CONTR LIC4: • CONTRACTCR: PF-CNE: — — * MAILING ACCFESS: * ***4*4*444*4*44444*4***** *****44* ***LAP****************44******************** MECFAN tCAL INFCRMATIGN * CONTR LIC4: x * C0 TRACT GR : PFCNE : * MAILING ADCSESS: * * ELECTRIC:__ GAS:___ CIL:___ CCAL:_— hCGD:___ cCLAR:___ FEAT FUNP:___ * x**x********xx*x*xxx*******************************s**z*xxx*x**xxxx****zx***** ***************************************************************************** ***, MECHANICAL FEES PLUMBING FEES ITEM DESCRIPTION PROCESSING FEE DUCTWORK SYSTEM wOCCSTCVE/INSERT GAS WATER HEATER GAS hTG EQUIP<IOC,000>BTU GAS hTG EQUIP+100,000 BTU GAS PIPING — # OF UNITS hEATPUMP 1-100M eTU HEATPUMP 101-500f' BTU HEATPUMP 501-1, 000M BTU HEATPUMP 1,001-1750P 8TU HEATPUMP +1,750M BTU REFRIG 1-100M BTU REFRIG 101-500M BTU REFRIG 501-1,000M BTU kEFRIC 1,001-1,750M BTU REI-RIG +1,750H BTU AIR CONDITIONER 0-3 HP AIR CONDITICNER 3-15 hP AIR CCNDI TICNER 15-3C HP AIR CCNC.IT ICNER 30-50 HP AIR CONOI TFC,ER +50 HP VENTILATING FANS EVAPORATIVE CCOLERS HOODS CLOTI-ES DRYER RANGE GAS LOG UNLISTED GAS APPLIANCE AIR HANDLER 1-10G0C CFM AIR HANDLER 10000+ CFM NUMBER CF YES OR NG ITEM DESCRIPTION PROCESSING FEE TOILETS SINKS SHOWERS BATE: TUBS KITCHEN SINKS DISH WASHERS GARBAGE DISPCSAL CLOTHES WASHER UTILITY SINKS ELECTRIC LATER HEATERS FLOOR DRAINS FLOCK SINKS BAR SINKS ROOF CRAINS LAWN SPRINKLER SEWAGE EJECTOR WATER SOFTENER URNAL DRINKING FOUNTIAN NUMBER OF YES OR NC . **1 x,4*xX ;4=4- ;v4x'eXXY4X4zkxXskxX-4X 1;Xrt.. ,Y i i• . Lt,X", ,,, * PCT?I1E rr_NE INFCRNATICN * CCNTR LIC4: * CONTRACTOR: PHCNE: - - * * * MAILING ACCRESS: * * PREVICLS ADDRESS: * LOCATION: PARCEL NLNEEP: STREET: * * CITY/STATE/ZIP: * MAKE: NCDEL :-- : * SEPIALk: NLOTF:: 8_ LENGTF:'I 4****4#4,44M###*kt##*444*****************#**************i******************** * RELCCATICN INFCRhATICN * CONTR LIC#: * CONTRACTOR: CITY/STATE/ZIP: * CONTRACTOR: * MAILING ADDRESS: FI-CNE: - - * * MAILING AOCRESS: * * PREVIOUS ACDPESS: * LCCAT ION: PARCEL NUMBER: * STREET: * * * * ********##*:44##*4#4#***************************************************T**** SIGN INFCPPATICN * CONTR LICh:_ * * * CONTRACTOR: FFCNE: - - * MAILING ADDRESS: w * SCUARE FOOTAGE: POLE FEIGNT:_____-_ * * # * ************444.4***************s********************************************** * DEMCLIT1CN INFCFNATICN * CONTR LIC#:_ * * * * * BUILCING SCUARE FOCTACE: * * FHCNE: * 4. A' t4****** *'C 4**4444 ***4****•**-tt '**-*s*** 4'!t#-********* f**a} 44,4*" **** f*****-44* d*** NUMBER CF BUILDINGS: ZONING ADJUSTOR SPOKANE COUNTY, WASHINGTON IN THE MATTER OF A CONDITIONAL USE ) PERMIT TO ALLOW A MANUFACTURED ) HOME TO TEMPORARILY HOUSE A FINDINGS, CONCLUSIONS DEPENDENT RELATIVE (CUE-35-87);) AND DECISION LESLIE FOGELSON SUMMARY OF APPLICATION: The applicant is the owner of approximately 2.5 acres of land, upon which he desires to establish a second residence for his brother, Clifton O. Fogelson. Section 4.04.170(jj) of the Spokane County Zoning Ordinance requires a conditional 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. LOCATION: The property is located in the Spokane Valley, north of Valleyway 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 property is addressed as North 601 Flora Road. DECISION OF THE ZONING ADJUSTOR: Based upon the evidence presented and circumstances associated with the project proposal, the Zoning Adjustor APPROVES the conditional use permit conditioned and stipulated as set forth below. PUBLIC HEARING: After examining all available information on file with the application, the Zoning Adjustor conducted a public hearing on November 17, 1987 rendered a verbal decision on November 17, 1987 and a written decision on November 20, 1987. FINDINGS OF FACT 1. The proposal is generally located in the Spokane Valley, north of Valleyway and west of and adjacent to Flora Road in the SE 1/4 of Section 13, Township 25, Range 44, and is further described as a portion of Assessor's Parcel No. 13544-0103, being more completely described in Zoning Adjuster File CUE-35-87. 2. The proposal consists of the applicant's wishing to establishing a small, used manufactured home, approximately 8 feet by 42 feet, on his property in the Spokane Valley for the purpose of housing his dependent brother. The manufactured home would be located behind an existing barn facility, which presently has electric power to it. The power would 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 would be run toward Flora Road into a facility presently used by the upstairs portion of the existing dwelling unit. The existing dwelling unit also has another sanitary waste disposal system for other portions of the house. There would be no new driveway accesses constructed. 3. The adopted Spokane 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 Plan. 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 compatible with the proposal. 6. Apparently the property is being divided into a two -lot short subdivision. In that.case, the right to establish 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 11.1 0.070(1)(a). 8. The applicant has been made aware of the recommendations of various County/State agencies reviewing this project and has indicated he can comply with those recommendations. 9. The proposed site plan indicates that setbacks, parking, height of the structure(s) will conform 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 4.24.560 of the Spokane County Zoning Ordinance; (b) that if the temporary residence is desired for more than one year the application will have to be renewed; and (3) that a Title Notice will be filed by Spokane County with the Auditor's 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 conclusion hereinafter stated which may be deemed a finding herein is hereby adopted as such. From the Findings, the Zoning Adjustor comes to these: CONCLUSIONS 1. The proposal is listed in the Spokane County Zoning Ordinance as a conditional use allowed in the Agricultural zone and the proposal does meet the established and applicable criteria described for that conditional use. 2. Various performance standards and criteria are additionally needed to make the use compatible with other permitted activities in the same vicinity and zone and to ensure against imposing excessive demands upon public utilities and these shall be addressed as conditions of approval. 3. The proposal will not be detrimental to the Comprehensive Plan or the surrounding properties. 4. The Zoning Adjustor may require such conditions 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 conclusion herein is adopted as such. FILE: CUE-35-87 ZONING ADJUSTOR DECISION PAGE 3 DEUCE From the foregoing Findings and Conclusions, the Zoning Adjustor APPROVES the proposal. The following CONDITIONS OF APPROVAL ARE STIPULATED. CONDITIONS OF APPROVAL I. GENERAL 1. The following conditions shall apply to the applicant, owner and successors in interest. 2. Failure to comply with any of the conditions of approval contained in this decision, except as may be relieved by the Zoning Adjustor, shall constitute a violation of the Zoning Ordinance and be subject to such enforcement actions as are appropriate. 3. This parcel shall not be further subdivided unless consistent with RCW 58.17, the various county subdivisions regulations and the Spokane County Comprehensive Plan for the area. 4. The Department of Building and Safety shall route the building permit application to all of the agencies and office of county government 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 will consult with the Planning Department if there are any changes resulting from review by the other departments when compared to the plans as approved by the Planning Department. Such review may necessarily result in a revision of the site plan for use by the Department of Building and Safety or possibly a withholding of the building permit until any conflicts are resolved. II. PLANNING DEPARTMENT 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) constructed in accordance with State of Washington or Federal manufactured home construction standards as evidenced by the attachment of an insignia; (c) designed for transportation after fabrication on public streets and highways on its own chassis and wheels; (d) skirted with a fire resistant material; (e) connected to electric power, water supply and sewage disposal facilities and other utilities as appropriate or necessary; and (f) the unit shall not be permanently affixed to the land, except for temporary connections to utilties. 2. The manufactured home shall be occupied by either the dependent relative and family, or by the relative with family providing care to the dependent relative owning and occupying the principal residence. The dependent relative is established as Clifton O. Fogelson. 3. Upon termination of the need for dependent relative care or the sale or lease of the property, the applicant shall remove the manufactured home from the site within forty-five (45) days. 4. A statement (Title Notice) shall be recorded by the Planning Department in the County Auditor's Office stating that the manufactured home is temporary and for 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 transferred with the property if it is sold or leased. 5. The temporary residence shall be "accessory" only to a parcel or tract of land under the ownership or lease by the applicant for the Conditional Use Permit. 6. Only one temporary residence may be permitted on a lot, parcel or tract of land under the ownership or lease by the applicant for the Conditional Use Permit. 7. The permit shall be granted for a period of one year and may be renewed administratively by the Zoning Adjustor or his/her designee upon the recertification: FILE: CUE-35-87 ZONING ADJUSTOR DECISION PAGE 4 (a) by a licensed physician that the medical problem still exists; and (b) by the original applicant that the need still exists. 8. The renewal period shall be the first day of the month occurring after 12 entire months pass since the date of this decision (December 1, 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 public hearing and reconsideration of the permit; the expense shall be that of the county's if such reconsideration takes place. 10. The manufactured home shall be located in substantial conformance with the site plan on file in the Planning Department and any modification of proposed location shall only be authorized by the Zoning Adjustor prior to location and erection at the site. The approved site plan is indicated by "Approved Site Plan - TGM, 11/18/88." 11. If a two -lot short subdivision is established on the parcel, the dependent relative privilege is established only on the portion fronting on Flora Road. III. DEPARTMENT OF BUILDING & SAFETY 1. The Department of Building and Safety shall route the building permit application to all of the agencies and office of county government bebw 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 will consult with the Planning Department if there are any changes resulting from review by the other departments when compared to the plans as approved by the Planning Department. Such review may necessarily result in a revision of the site plan for use by the Department of Building and Safety or possibly a withholding of the building permit until any conflicts are resolved. IV. UTIUTIES DEPARTMENT 1. The owner(s) or successor(s) in interest agree to authorize the County to place their name(s) on a petition for the formation of a ULID by petition method pursuant to RCW 36.94, which petition 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 result of improvements called for in conjunction with the formation of a ULID by either petition or resolution method under RCW Chapter 36.94. NOTE: Planning Department 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 authorization is conditioned on compliance with all rules and regulations of the Spokane County Health District and is further conditioned and subject to specific application approval and issuance of permits by the Health Officer. 3. Any water service for this project shall be provided in accordance with the Coordinated Water System Plan for Spokane County, as amended. V. HEALTH DISTRICT 1. Sewage disposal shall be as authorized by the Director of Utilities, Spokane County. 2. Water service shall be coordinated through the Director of Utilities, Spokane County. 3. Water service shall be by an existing public water supply when approved by the Regional Engineer (Spokane), State Department of Social and Health Services. FILE: CUE-35-87 ZONING ADJUSTOR DECISION PAGE 5 4. Subject to specific application approval and issuance of permits by the Health Officer, the use of an individual on -site sewage system may be authorized. 5. Use of private wells and water systems is prohibited. VI. ENGINEERING DEPARTMENT 1. None is applicable. NOTICE: PENDING COMPLETION OF ALL CONDITIONS OF APPROVAL WHICH NEED TO BE COMPLETED PRIOR TO PERMIT ISSUANCE, PERMITS CAN BE RELEASED PRIOR TO THE LAPSE OF THE (1 0)-DAY APPEAL PERIOD. HOWEVER, THE COUNTY HAS NO UABILITY FOR EXPENSES AND INCONVENIENCE INCURRED BY THE APPUCANT IF THE PROJECT APPROVAL IS OVERTURNED OR ALTERED UPON APPEAL. DATED this 20th day of November, 1987. Thomas G. •�er, AICP Zoning • ster Spokane County, Washington FILED: 1) Applicant 2) Parties of Record 3) Spokane County Engineering Department 4) Spokane County Health District 5) Spokane County Utilities Department 6) Spokane County Department of Building & Safety 7) Planning Department Cross-reference File and/or Electronic File NOTE: ONLY THE APPUCANT OR AN OPPONENT OF RECORD MAY FILE AN APPEAL WITHIN TEN (10) CALENDAR DAYS OF THE ABOVE DATE OF SIGNING. APPEAL MUST BE ACCOMPANIED BY A $100.00 FEE. APPEALS MAY BE FILED AT THE SPOKANE COUNTY PLANNING DEPARTMENT, BROADWAY CENTRE BUILDING, NORTH 721 JEFFERSON STREET, SPOKANE, WA 99260. (Sections 4.25.090 and 4.25.100 of the Spokane County Zoning Ordinance) fcu Spokane County Department of Building & Safety JAMES L. MANSON, DIRECTOR TO Tom Mosher Planning Department FROM om Davis --1 Department of Building and Safety DATE: November 3, 1987 RE November 17, 1987 Adgenda 1. CUE-35-87 - North 601 Flora Road FINDINGS: In accordance with Section 301 of the Uniform Building Code, all buildings and structures including mobile homes and fences over six feet in height requires the issuance of a building permit by the Department of Building and Safety. Project is located within Fire District No. 1. 2. CUE-29-87 - North 6109 Harvard Road FINDINGS: In accordance with Section 301 of the Uniform Building Code, all buildings and structures including mobile homes and fences over six feet in height requires the issuance of a building permit by the Department of Building and Safety. Project is located within Fire District No. 1. 3. NCE-17-86 - Sandy Beach Resort (Neyland Avenue) FINDINGS: In accordance with Section 301 of the Uniform Building Code, all buildings and structures including mobile homes and fences over six feet in height requires the issuance of a building permit by the Department of Building and Safety. Project is located within Fire District No. 1. The required fire flow is determined by the district. NORTH 811 JEFFERSON • SPOKANE, WASHINGTON 99260.0050 • TELEPHONE (509) 456-3675 LESLIE FOGELSON N VERA S 1/2 S 1/2 B.1 w F— 3/16" = 17' S n SPOKANE COUNTY PLANNING DEPARTMENT APPLICATIONS BEFORE THE ZONING ADJUSTOR/BOARD OF ADJUSTMENT Certificate of Exemption #: Application #: 3,5—' Y 17 Name of Applicant: 5 CI Street Address: N Home: Ci� ;-_�3E, City: (.210...E.f- le 7 _ State: Li t Zip Code: 9qD 37 Agent: Name of Property Owne r(s) : ,L,, , - €. T REQUESTED ACTION(S) (Circle. Appropriate Action) : Variance(s) Qonditional Use Permit Waiver of Violation Temporary Use/Structure Non -Conforming Lot/Use Other: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *Cite Ordinance Section: * *Section * *Existing Zoning: *PSSA:' N UTA: *Hearing Date: ** * * * * * * * FOR STAFF USE ONLY ** * * -� . z/ t (, Old Code: r/ New Code: L ,..- Range < < ( PropertySize: 9 f,� � :a-1' ii / * F.L.U.P. Designation: \ (,e,�rct. FIRE DIST.:#2__ LEGAL CHECKED BY: Staff taking in Application: k***.k************* it, * w w * * * * * * N ASA'%YN // -/' �7 Existing Use of Property.: c e, Describe Intended Proposal: 0,ni d 1-)-1 n no_ 1 -co r e rn p ora rL Mob, I hone- -COY ,AePen ec,r- f 1 a P f VYl e e± O -t x Iri 1fir'e_• Street Address of Property: JV (2 01 l A Legal Description of Property (Include easement if applicable): o 0--C 8 1 [74-4,7 4--r) Parcel #: 1 3 54- 4- - 0 i D 3 t"' Source of Legal :1 T A v1 Total amount of adjoining land controlled by this owner/sponsor.: Q 1r� What interest do you hold in the property; f-Ne - D1 /Ti±le_ ).Q )d Please list previous Planning � Department actions involving this property: r1-en 4714i r n tO s k0 r+ 1 `: :? UNDrR THE PENALTY OF PERJURY, THAT: (1) I AM THE OWNER OF RECORD OR AUTHORI- ZED AGEN1 FOR THE PROPOSED SITE; (2) IF NOT THE OWNER, WRITTEN PERMISSION FROM SAID OWNER AU1'HORIZiNG MY ACTIONS ON HIS/HER BEHALF IS ATTACHED; AND (3) ALL OF THE ABOVE RESPONSES NiD THOSE ON SUPPORTING DOCUMENTS ARE MADE TRUTHFULLY AND TO THE BEST OF MY KNOWLEDGE. NOT ,.RY Signed: Addtiess: _. �llZ,�p i„ Phone No.: _4,11 Notary: - z�� Date: 7 ate: aLl2_7 (eve0 A. BURDEN OF PROOF It is necessary for the applicant or his/her representative to establish the reasons why the requested proposal should be approved and to literally put forth the basic case. Accordingly, you should have been given a form for your requested action (variance, conditional use, etc.) designed to help you present your case in a way which addresses the criteria which the Zoning Adjustor must consider. Please fill the form out and return it with your application. If you didn't get a form, ask the Planning Department personnel for advice on how to proceed. B. SIGN -OFF BY COUNTY DEPARTMENTS COUNTY HEALTH DISTRICT a) Proposed method of water supply: b) Proposed method of sewage dis A preliminary consultation haseen t has be i o ed of requireme a't u /6 COUNTY ENGINEER'S DEPARTMENT A preliminary consultation has been held to discuss the proposal. The appli- cant has been informed of requirements and standards. ;Ye; f� -44 c ,z„„ Date 6 held to discuss the proposale appli- ts and standards. Si gn- Signature COUNTY UTILITIES DEPARTMENT (Waive if outside WMAB) ("1 (Sign -off Waived) A preliminary consultation has been held to discuss the proposal. The applicant haseri informed of requirements and standards. •-•/?--437 ignature) Nate) (Sign -off Waived) 0* The applicant is required to discuss the proposal with to become informed of sewage disposal requirements and standards. ( ✓r The applicant is required to discuss the proposal with V,t to become informed of water system requirements and standards. WATER PURVEYOR (Waive if outside CWSSA) NAME: a) The proposal is/.. located within the boundary of our future service area. b) The proposal is/tameet located within the boundary of our current district. c) We are/aft able to serve this site with adequate water. d) Sa'sfact arrangements brae/have not been made to serve this proposal. (Date) Signature 5. SEWERAGE PURVEYOR NAME: N (Sign -off Waived) (If other than Spokane County) ( 1 A preliminary consultation has been held to discuss the proposal. The applicant has been informed of requirements and sta (.Signature) (Date) _Si g -off ai ved R;r}-'t" STATEMENT OF ATTENDING PHYSICIAN FOR DEPENDENT RELATIVE S►O.AMC COu.T• COu.r KOuSE To assist in meeting the requirements of the Spokane County Zoning Ordinance, Section 4.24.560 b.2. and 4.03.020 19 G, concerning a licensed physicians statement regarding the nature of the medical problem and the definiton of "Dependent", I submit the following information. 1) Full name of person(s) for which information is given below: ►--) D, F Q cam\ Q r 2) Describe the nature of the medical or health related circumstance(s), physical and/or medical which establish a "dependency" situation: x v4 3) Is this a circumstance of short o log term duration:' 4) The Spokane County Zoning Ordinance defines a "dependent" rela as a relative who has been determined by a licensed physician to b hystca1 y , or mentally incapable of caring for themselves and/or their prop rty:--D6 you believe your patient is so qualified at the present time? Yes No 0035z (Physician's Name) (Business ddress) ( ;� /V2 (Si a ure) (Date) CHARLES W. RANCE. M.D. ALLENMORE MEDICAL CENTER STE A211 TACOMA, WA 9S405 STATEMENT OF ATTENDING PHYSICIAN FOR DEPENDENT RELATIVE To assist in meeting the requirements of the Spokane County Zoning Ordinance, Section 4.24.560 b.2. 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 information. 1) Full name of person(s) for which information is given below: 0, Foce.s° �n 2) Describe the nature of the medical or health related circumstance(s), physical and/or medical which establish a "dependency" situation: tt-C yietA Clag.L1:&) ( /d J v 3) Is this a circumstance of short or long term duration: 4) The Spokane County Zoning Ordinance defines a "dependent" relative as a relative who has been determined by a licensed 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? Yes No 0035z John R. Macdonough, M.D. B6007( AlYlenmoareCenter) Tacoma WA 98405 (g siness Address) vt_w `ffl Gam4 (Signature) /36 /- (bate) SPC"-.0 C�lh+r [��qt nCUSC STATE OF WASHINGTON ) } COUNTY OF SPOKANE ) Applicant AFFIDAVIT OF DEPENDENT RELATIVE CIRCUMSTANCES (THIS STATEMENT MUST BE NOTARIZED) , being duly sworn on oath deposes and says: 1) I am the owner, leasee or contract purchaser of the following property: Assessors Parcel #: / 2 r yC`/ - 0 / 0 ,3 Legal Description: (JP r , ,S '/a ,-f 5''z 6 r (continue separate sheet) 2) I seek to house C / / ..c - r Fm/z io n full name(s) of dependent elative(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: 17) rn - h e r- 4) The above named relatives are dependent upon me because of the following circumstances: {-A€-o.r- , (� . r v � ►3 e-s ) --unr_�1or.a�LLti rfl1'kc-r�e< or�c�o,r� Me�►Coc.�lo J g PussihIe_ mecd► c t eDie r ene(es ; & i yrs, ©1& 5) In your opinion, is (are) the above person(s) physically or mentally in- capable of caring for themselves and/or their property? 3Z. Yes No 6) I fully understand I am responsible 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. Print/Type Name.J �D� � SUBSCRIBED and sworn before me this — SEAL: 0034z 'day of S gnature���t c7 1Cyr � 4 , 19 /7 . otar/ u is nd of rteSt ate of Washin ton, residing,,pt s- j�l,5,e Pl,lc`--47e. / .