CE-510-92Alariciq
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APPLICATION FOR CERTIFICATE OF EXEMPTION`
APPLICATION FEE .%"" /Jg ://o/. .
1. Applicant's Name: John Toothaker
Address: 1 1 1 15 E. Empire
City: Spokane State: Wa. Zip• 99206
2. Legal descripti9n of property for which this "Certificate of Exemption" is being applied:
Section: _4 Township .25—N- Range 4Y4t within Spokane County, Washington.
APPLICATION NO
Home Phone: 928-5363
Business Phone:
The Easterly one half Lot S. Block 4 Snl-h of the R R 1j/W
and the Northerly 115 feet of the Easterly 37_fe,=t of the
Westerly one half of T.ot 5. Block 4. South of the R.R'_ R/W.
in Granrlvi ew Arres as rernrded in Rook 'R". page 12 of Plats
in Spokane ronnty WA
3. Tax parcel number L/ 5.0Y3, 07// 0S, /04. Property size: (sq. ft. or aces)
5. Zoning: (/27.J ¢. Comprehensive Plan category:
7. intended use of property try ce
8. For all 3.3(b)(2) and 33(e)(d) exemptions, the Spokane Co ty Health District must complete the following:
A preliminary consultation has been ma
informed of applicable rcquircm
55 Act.
U 39
scuss the
0Cer ate pf emption. The applicant has been
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Date
9. I, 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 that 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 ieliance on this
applicati
C'a iin ,,o v���
Notary Publi6'in and for the State o iggton
Residing? a: e,vr,�. • e�j.'7o'C�S,.1
My appointment expires <') IqS
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NOTARY SEAti(2�•:S7�gq;o1;.•G
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STAFF ONLY
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SUBDIVISION
APPROVED/DENIED FORSAIDPROPERTY DE$CRIBEDSTRATOR FINDS THAT THIS �O PURSUTIFICATE OFEXEMPTION"
NT TO SPOKANE
COUNTY SUBDIVISION(S) SECTION '3 34
THIS CERTIFICATE OF EXEMPTION SHALL BE S`UB ECT TO THE FOLLOWING CONDITIONS
AND/OR FINDINGS:
1. The applicant shall comply with all requirements and regulations of the Spokane County Zoning Code.
2. 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 MW SHALL RUN 'I THI TREt AND a T; cyan BE
APPLICABLE TO THE APPLICANT, OWNER, THEIR HEIRS, SUCCESSORS OR ASSIGNS.
APPROVE /DENIED THIS /0 DAY OF ,-f , 19 gZ-
c
0�
THIS CERTIFICATE MUST ACCOMPANY YOUR BUILDING PERMIT APPLICATION
SPOKA.NE COUNTY PLANNING DEPT., 72I N. JEFF:ERSON, SPOKANE, WA 99260 (509)456-2205
CERTIFICATE OF EXEMPTION ISSUED BY SPOKANS COUNTY, WASHLNGTON