CE-396-78APPLICATION FOR CERTIFICATE OF EXEMPTION
PLEASE PRINT OR TYPE
Applicant's Name: 12e.10,,,t,Phone: Res: efp:/ Bus:
Address: 5 44Ill'vukr- - City: Vkle_vu--4A�k-c State: t ,��� ZIP: q 67j7
11.
1
12. Legal Description of property for which this "Certificate of Exemption" is being applied
for: Section /?( Township ,145- Range r/S
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I� �31oc+•,
Gv'e e! ti Vc51.
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3. Parcel Number (From Tax Statement or Assessor's Office): # / 6 5 S / 6 3 7-
4. Size of said property: Square Feet: 0 c 9S v 0r Acres:
5. For which of the following reason(s).do you believe you qualify for a "Certificate of
Exemption"?:
(For each box checked, please submit the listed documentation required to substantiate
your exemption. In addition, please submit an assessor's map and an ownership micro
run of your property, both obtainable from the Tax Assessor's Office, with your ap-
plication).
0 A. Division of land ten (10) acres or larger
DOCUMENTS OF PROOF: 1) Assessor's map and ownership micro run as requested
above.
0 B. Minor boundary or lot line adjustments
DOCUMENTS OF PROOF: 1) Adjusted legal description; 2) Copy of sales/contract
agreement.
LJ The reconveyance of old lots, tracts, or parcels of land which were separate
and distinct when purchased, although the purchase thereof makes the divisions
contiguous.
DOCUMENTS 0F. PROOF: 1) Copy of tax statement; 2) Copy of deed or dated copy of
sales/contract agreement
L] D. Division of land created prior to March 13, 1978, which is five (5) ,acres or
larger.
DOCUMENTS OF PROOF: 1) Copy of deed or dated copy of sales/contract agreement.
l___1 E. The purchase of one separate and distinct parcel of land prior to March 13, 1978.
DOCUMENTS OF PROOF: 1) Copy of deed or dated copy of sales/contract agreement.
F. A division of land to a spouse, son or daughter
DOCUMENTS OF PROOF: 1) Copy of deed/Quit Claim Deed or dated copy of sales/con-
tract agreement. 2) Notarized affidavit attesting to said relationship.
. Additional comments which may substantiate your qualification for an exemption:
el pi i tic -f8V. S{- 17Y�d1� do �-y-�Svcc-t 13 ) 1e 77
I, the undersigned, swear under the penalty of perjury, that the above responses are made
truthfully and to the best of my knowledge. I also agree to furnish any further documen-
tation that may be required by the Short Plat Administrator and I hereby agree to waive
the five (5) day approval period as specified in the Short Plat Ordinance if further infor-
mation is required. I also understnad 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 reliance of this application.
NOTARY SEAL
Signed:
Notary:
r A`1 1 `i 1978
SPOKANE COUNTY
PLANNING DEPARTMENT
Date: 5 / JO /7
Date: / /
APPLICATION NO. L'L O<39'4 -7
SPOKANE COUNTY SHORT PLAT SUBDIVISION ORDINANCE
NOTICE OF ACTION ON CERTIFICATE OF EXEMPTION APPLICATION
1 Whereas, the Board of County Commissioners did, after public hearing on March 9, 1978, adopt
the Spokane County Short Plat Subdivision Ordinance, and
1 .
Whereas, the Board of County Commissioners in adopting this Ordinance did provide for certain ,
activities to be exempt from short platting activities, and
•
Whereas, the Board of County Commissioners did further provide for these certain activities
to receive a "Certificate of Exemption" from the Short Plat Administrator prior to the re-
lease of a building permit, and
Whereas, the Short Plat Administrator has received a request for a "Certificate of Exemption"
for certain property located in the unincorporated territory of the County of Spokane, and
Whereas, the Short Plat Administrator has reviewed the evidence presented by the applicant
and all other information available, the Short Plat Administrator hereby takes the following
action on this "Certificate of Exemption" application, pursuant to the Spokane County Short
Plat Subdivision Ordinance.
C-A-PPROVAL
- Certificate of Exemption
The Short Plat Administrator finds that a
"Certificate of Exemption" should be and
hereby is issued for said property, as de-
scribed on the reverse side, pursuant to
Spokane County Short Plat Subdivision Or-
dinance Section 3.73 .
Approval of said "Certificate of Exemption"
and issuance of building permits, shall be
subject to the following conditions:
1. The applicant shall comply with all re-
quirements and regulations of the Spokane
County Zoning Ordinance.
2. The applicant shall comply with all re-
quirements of the Spokane County Health
District regarding the placement of on -
site water and/or sewage systems.
4.
This "Certificate of Exemption" is and shall
run with the land and shall be applicable to
the applicant, owner, their heirs, succes-
sors or assigns.
APPROVED THIS !. DAY OF
tt,LShort Plat Administrator
SPOKANE COUNTY
PLANNING DEPART-
MENT STAMP
DENIAL
- Certificate of Exemption -
The Short Plat Administrator finds that a
"Certificate of Exemption" should not and
hereby is not issued for said property as
described on the reverse side, pursuant to
Spokane County Short Plat Subdivision Or-
dinance Section , for the follow-
ing reasons:
1.
2.
3-
According to the Spokane County Short Plat
Subdivision Ordinance, the division of
land that you propose to develop is defined
as a Short Plat and you will be required to
comply with the requirements of said Ordin-
ance prior to issuance of building permits.
DENIED THIS DAY OF
19
Short Plat Administrator
SPOKANE COUNTY
PLANNING DEPART-
MENT STAMP
THIS CERTIFICATE MUST ACCOMPANY
YOUR BUILDING PERMIT APPLICATION
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