CE-807-94B1.
6
APPLICATION FOR
CERTIFICATE OF EXEMPTION
APPLICATION NO. (Fr C 9'i �T(/
COMPANION FILE NO. --5 5 3 — ci
SP
°"""` `°°"'" `°°" "°°S` /�f Business Phone: �r Y- 3 57-7-
Applicant's Name: 0,14 0 /ntc,GU-ram' CCoprik Home Phone: 42-6 —
Address: 4 O. Be:( 13'7/7 -
City: Sjz)evvc! a State: WA- Zip: 99 >!3 -
2. LEGAL DESCRIPTION of property for which this "Certificate of Exemption" is being applied: . ....
NOTE: if the property is being divided or changed - - - provide the NEW LEGAL DESCRIPTION below.
Section 7 Township z SW Range 4'VF within Spokane County, Washington.
. continued °n back
3. Existing tax parcel number(s) 07 5 -•7 47)1--
4. Total existing acreage Veil 5—+t 5. New property size: (sq.ft. or acres) / a a -s-0
6. Zoning: & Q -.7, 5 7. Comprehe ' e Plan Category: (/R R mot-/ -
8 . Existing or intended use of property: /Pcz$rne
. contanued9t bate
9. Existing road frontage name: riuv9e.eTv//1 Feet of Frontage Se?,
NOTE: Minimum Road Frontage must extend into or be adjacent to the property as required per ZONING. If access is
by Private Road, a copy of recorded Private Road Easement must be provided with this application and the AUDITOR
RECORDING NUMBER entered
ed as "Existing road frontage name" above.
10. I, lNds6y e&a625 f,e CAN (print name), swear under penalty. of perjury that
the above �tesponses are tzfade truthfully and to the best of my knowledge. I also agree to
furnish any further documentation that may be required by the Planning Department. 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
reliance on this application. I also have provided written permission from both property
owners, if this application is for , or lot line adjustment."
SIGNED:
t
STAFF ONLY
THE PLANNING DEPARTMENT ISSUES THIS "CERTIFICATE OF EXEMPTION" AS INDICATED
BELOW FOR THE PROPERTY DESCRIBED ABQ'E.-'UR UANT TO SPOKANE COUNTY
SUBDIVISION ORDINANCE, SECTION '7 t C t
THIS CERTIFICATE OF EXEMPTION SHALL BE SUBJECT TO THE FOLLOWING
CONDITIONS AND/OR FINDINGS:
The applicant shall comply with all requirements and regulations of the ZONING CODE of Spokane County.
The applicant shall comply with all requirements of the Spokane County Health District and/or Utilities
Division and/or County Engineering Division regarding wastewater disposal, on -site water or public water
systems and access and roads, respectively.
If above legal is new, the applicant shall file SEGREGATION APPLICATION with the County Assessor as
soon as possible after this application is approved. Not required when denied.
4. If private road is used, no building permit can be issued until the standards Chapter 3.05.050 of the County
Code have been complied with for the location and construction of the private road r
The applict sh• 1 comply with e folio ' g additional conditions:
�L7,iLr7,Ili'�l!1.. .cmvnu • on wee
( TH T (7' r� .XE'P - 7 ,0L R WITH THE LAND, AND SHALL
BE APPLICABLE TO THE APPLICANT, OWNER, HEIRS, CC SSO S OR ASSIGNS.
' • • e s ,,s v'e'r : THIS DAY OF (J�,%t� 19 %
ECEIPT NUMBER Spokane County Plano g Department
THIS CERTIFICATE OF EXEMPTION ISSUED BY SPOKANE COUNTY, WASHINGTON
SPOKANE COUNTY PLANNING DEPT., 721 N. JEFFERSON, SPOKANE, WA 99260 (509)456-2205
TEM CERTIFICATE MUST ACCOMPANY YOUR !: UE DI NG PERMIT APPLICATION
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