CE-397-78APPLICATION FOR CERTIFICATE OF EXEMPTION
PLEASE PRINT OR TYPE
1. Applicant's Name: VdY Asta\‘. Phone: Res: e7yy/ E/6 7Bus: %� =529
Address: S e// 1 U .506 6 v ry City: State: ZIP:
2. Legal Descriptions f property for which this "Certificate
for: Section lb: Township Range
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Vo I 5 5 - d a-� �I c� -t S 5 Toms--(
of Exemption" is being applied
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3. Parcel Number (From Tax Statement or Assessor's Office): # % 6
4. Size of said property: Square Feet: I U 9 5 0 0r Acres:
5. For which of the following reason(s) do you believe you q" 1ify for a "Certificate of
Exemption"?:
(For each box checked, please submit the listed
your exemption. In addition, please submit an
run of your property, both obtainable from the
plication).
i f A. Division of land ten (10) acres or larger
DOCUMENTS OF PROOF: 1) Assessor's map and ownership micro run as requested
above.
U
0
El D.
Il E.
documentation required to substantiate
assessor's map and an ownership micro
Tax Assessor's Office, with your ap-
B. Minor boundary or lot line adjustments
DOCUMENTS OF PROOF: 1) Adjusted legal description; 2) Copy of sales/contract
agreement.
C. 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 OF PROOF: 1) Copy of tax statement; 2) Copy of deed or dated copy of
sales/contract agreement
of land created prior to March 13, 1978, which is five (5) acres or
Division
larger.
DOCUMENTS OF PROOF:
The purchase of one
DOCUMENTS OF PROOF:
1) Copy
separate
1) Copy
of deed or dated copy of sales/contract agreement.
and distinct parcel of land prior to March 13, 1978.
of deed or dated copy of sales/contract agreement.
0 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.
6. Additional comments which may substantiate your qualification for an exemption:
c i I vcA fc r- 5c9. 4-- I, rQ e„..— ; 9 c v- \ 3 t q -78
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. J
NOTARY SEAL
Signed:
Notary:
RECE ._
rvi AY 1 .0
Date: ,'rj / /CS / %K-
Date:
SPOKANE COUNTY
PLAAINING DEPARTMENT
APPLICATION NO.(,- 0 3i7
SPOKANE COUNTY SLORT PLAT SUBDIVISION ORDINANCE
NOTICE OF ACTION ON CERTIFICATE OF E2EMPTION APPLICATION
Whereas, the Board of County Commissioners did, after public hearing on March 9, 1978,
the Spokane County Short Plat Subdivision Ordinance, and
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 t'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.
adopt
APPROVAL
- Certili a e oI Lxemption -
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 ShortPlat Subdivision Or-
dinance Section 3- E-t3Cc).
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.
3-
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 / c DAY OF
197.
Cam-'
CI Short Plat Administrator
SPOKANE COUNTY
PLANNING DEPART-
MENT STAMP
DENIAL
- Certificate of Exemption -
The Short Plat Administrator finds that a
"Certificate of Exemption's 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
YOUR CERTLriBUILDING
MUST ACCOMPANYLCAT
YOUR BUILDING PERMIT APPLICATION