CE-406-78APPLICATION FOR CERTIFICATE OF EXEMPTION
PLEASE PRINT OR -TYPE
1. Applicant's Name: ,,eQ /,4,Phonne: Res: P --/6/§- Bus: .,��
Address: '/O /4e#� City: � .�3� State: / _ ZIP :y4, 76
2. Legal Description of property for which this "Certificate of Exemption" is being applied
for: Section d Township ; Range 7,
Parcel Number (From Tax Statement or Assessor's Office): # g7t) 5-97
3•
4. Size of said property: Square Feet: // efx:A) Or Acres:
5. For which of the following reason(s).do you believe you qualify for a
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
0
0
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truthfully and to the best of my
Itation that may be required by
the five (5) day approval peri
mation is required. I also
or willful lack of full discl
it might issue in reliance of
NO 'ARI ,SEAL
"Certificate of
A. Division of land ten (10) acres or larger
DOCUMENTS OF PROOF: 1) Assessor's map and ownership micro run as requested
above.
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
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.
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.
6. Additional comments which may substantiate your qualification for an exemption:
I, the undersigned, swear under the penalty of perjury, that the above responses are made
owledge. I also agree to furnish any further documen-
/
e Short Plat Administrator.and I hereby agree to waive
d as specified 'n the Short Plat Ordinance if further infor-
derstnad that, ould there be any willful misrepresentation
sure on my p .. , . po /' ounty may with. = any approval that
this applica''ion. togO°7—P,� -.,z//irr
Signe
Notary.
!Lz,,1_
/
SPOKANE COUNTY
PLANNING DEPARTMENT
APPLICATION NO, �C= `yt �,-
SPOKANE COUNTY SHORT PLAT SUBDIVISION ORDINANCE
NOTICE OF ACTION ON CERTIFICATE OF EXEMPTION APPLICATION
Whereas, the Board of County Commissioners did, after public hearing on March 9, 1978, adopt
the Spokane County Short Plat Subdivision Ordinance, and
B 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.
•••. ...01)
1
APPROVAL,
- Cer '`icate 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.Sil (i) .
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. (6-n--p (,c. -(-•e , �� x aL �trc �w�`'c� (err ✓� . ti i�
u
p
/ v
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 /6 DAY OF
192.LS.
cri. Short 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.
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 Administrate:'
SPOKANE COUNTY
PLANNING DEPART-
MENT STAMP
4
THIS CERTIFICATE MUST ACCOMPANY
YOUR BUILDING PERMIT APPLICATION