TC 2013102663 11247 Morris Rd SE COUNTY CONII�TISSIONERS
�� Cathy��'olfe
District One
Sandra Romero
District Two.
THURSTON COUNTY � Karen Valenzueia
� District Three
SINCE 1552
RESOURCE STEWARDSHIP DEPARTMENT
Creating Solutions for Our Future Cliff Moore
Director
TRANSMITTAL MEMORAND UM
; / Date Submitted ��
PROJECT NAME: V���j I Z�,� - C��.�I �I��I�I ��
PROJECT NO.: 20 I� I O�O� lo��
FOLDER SEQUENCE NO.: i 3 1 C��� q (� ��t
RELATED CASES LISTED BY SEQUENCE NO.: .
�SUBAREA# q �FIRE DISTRICT# � — `��(�
❑ SCHOOL DISTRICT(Lts� ADJACENT���S�DICTION�LisT�
❑PHONE COMPANY ❑TC PUBLIC WORKS—UTILITES - J.King
❑AGRICULTURE COMM ❑ WATER RESOURCES—tt.t,�g�►
❑TCONIM 911 ❑ORCCA
❑TC ENVIRONMENTAL HEALTH ❑WILLIAMS GAS PIPELINE—wEST �
❑TC PUBLIC WORKS -DEVELOPMENT REVIEW ❑PUGET SOLTND ENERGY
❑TC PUBLIC WORKS—RIGHT-OF-WAY �WA DEPT OF FISH & WILDLIFE
❑ WA DEPT OF TRANSPORTATION- D.Severson �G.ROGERS []M.SCHIRATO
❑ TC FIRE MARSHAL �WA DEPT OF ECOLOGY
0 TC FLOOD REVIEW [] SHORELINE REVIEW �ENVIRONMENTAL REVIEW
�TC BUILDING PLAN REVIEW 0 US ARMY CORPS OF ENGINEERS
j�C.Edmark-Commercial []Dock Review ❑ WA DEPT OF NAT RES - Pacific Cascade Region
❑TC NOXIOUS WEEDS ❑TC ADDRESSING �
�TRIBE-�NISQUALLYrjSQUAX1Nj�CHEHALIS 0 TC ASSESSOR�S OFFICE-PROPERTYCONTROL
❑HENDERSON INLET ❑TC SHERIFF'S OFFICE
�NISQUALLY REACH ❑AT& T BROADBAND
�VEENA TABBUTT—T.R.P.C. ❑THURSTON P.U.D.—J.WEIDENFELLER
�THURSTON CONSERVATION DISTRICT ❑INTERCITY TRANSIT-D.Br.00M
❑ WATER RESOURCES—M.Biever(Geotech xeview) ❑ OTHER
PLEASE SEE REVERSE SIDE FOR LIST OF REPORTS SUBMITTED WITH APPLICATION.
Please review the enclosed project information and notify our office in writing of any comments or
recommendations on or before the date noted below. Your comments will become part of the record and
utilized in the decision-making process by staff or the Heari.ng Examiner. "No comment"by the due date
will be considered an indication that the application is complete.
Department: Complete 0 Incomplete� Not Applicable❑
Signature• Date•
Please return comments to:,��
���� Nd�T�� by S:OOpm on: tp ��
2000 Lakeridge Drive SW,Olympia, Washington 98502(360)786-5490/FAX(360)754-29i_�����ED
� TDD(360)754-2933 Website: www.co.thurston.wa.us/oermittina � �
:,UN 072013
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Thurston County Permit Assistance Center
2000 Lakeridge Dr.SW,Olympia,WA 98502
�`*�r (360)786-5490 / (360)754-2939(Fax)
��'� x�=`� TDD Line(360)754-2933
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� � =� �_,_ Email:permit(a��co.thurston.wa.us
THCTl�S'����T �O�[J1�1`T� w'ww•co.thm•ston.wa.us%permittine
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- - Creating Solutions for Our Future
MASTER APPLICATION
STAFF USE ONLY _ DATE STAMP
13 107596 ZM
Permit Type: Special Use Permit � (°y�����
Sub Type: WCF Co-location �H�������'�.�
Work Type:
site: 11247 MORRIS RD SE YELM WA 98597 �py 312013
Assessor Property ID: 22730430400 �CE CE�,�E�
Applicant:Rick Cardoza/Land Development Consuttants Inc C� ��R�`.� p�S�StA
Owner: JUSTMAN FAMI�Y LLC '��
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Intake by: �i " � � �L
The Master Application is required for all projects and shall accompany a project-specific supplemental
application(s). The Master Application may not be submitted alone. Check the appropriate box for each
supplemental application being submitted with this Master Application.
T e of Pro�eCt(check all that apply):
BUILDING PLANNING
Residential(form SAOOI) - - Administrative Variance(�orm SAO21)
I ONon-Residential(�'orm SA0o2) �Binding Site Plan(form SA022)
0 Non-Residential Hood&Duct(form SA003) OBoundary Line Adjustment/Lot Consolidation(f'orm SAO23)
0 Non-Residential Sign(>'orra SAOO4) �Critical Area Administrative Review(f'orra SAO24)
�Manufactured Home Placement(form SAOOS) �Critical Area Review Permit�'orm SAO24a)
�Minor Permit(�orm SAOO6) �Critical Area Determination(form SA024b)
(MechanicaUPlumbing/Fire/Re-roof/Re-siding/Demo) �Design Review(f'orm SA025)
0 Adult Family Home Inspection(f'orm SA007) �Division of Land(f'orm SA026)
�Fire Code Permit(form SAO08-SAOl2) �Division of Land Final Map(form SAO26a)
� �Environmental Checklist(SEPA)(}�orm SAO27)
ROADS �Forest Practice Activities(>'orm SAO2s)
�Encroachxnent Permit(f'orm SA013) �Innocent Purchaser(form SAO29)
0 Construction Permit(form SA014) 0 Joint Aquatic Resources Permit Application(JARPA)
Q Val'ianCe(form SA01 S) (form SA030)
�Scoping Review Request(}�orm SAOISa) �Legal Lot Determination(f'orm SA031)
0 Access Permit(�'orm SAOISb) DOther Administrative Actions(�'orm SA032)
�Presubmission Conference(form SAO33)
ENVIRONMENTAL HEALTH OReasonable Use Exception(form SA034)
❑On-Site Sewage System(form SA016) �Release of Moratorium(form SA035)
I 0 On-Site Sewage System Abandonment(�'orm SAO17) �Rezone,Comp Plan Amendment,Open Space(�o�SA036)
0 On-Site Sewage Evaluation(}'orm SA018) 0 Shoreline Administrative Variance(jorm SAO37)
0 Water System Design(Group B or 2 Party)(�orm ❑Site Plan Review(�'orm SA038)
SA019) �Special Use Permit(f'orm SA039)
❑Well Site(�'orm SAO20) 0 Variance-Hearing Examiner(form SA040)
Revised 7-25-12 Form No.MA001
.a�fiF-i
Thurston County Permit Assistance Center
Master Application , ,
Page 2 of 3
_ .. _
Property Taz Parcel Number(s): �' x� �
22730430400_:; v5
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?,. .. . _ ..�� � ...<' )'— ...__...... `-�.
Zoning: RH1/5,RES;RRH1/5,RES/RESOURCE Acreage:
Subdivision Name(if applicable): Lot#:
Property Address: 11247 Moms Road SE City: yelm State: WA Zip Code: 98597
Directions to the Property:
!From WA-507 S,turn left onto Ball Hill RD SE c y
Take the lst right onto Moms RD SE
Take the 1 st right onto Lauker Ln SE
_ , .__ , .: . , _ '
_ -
Property Access Issues ocked g�e,code required,dogs or other animals): QNo QX Yes
If yes,Describe: - � �Z�
OWNER IS RESPONSIBLE FOR SECURING ANIMALS BEFORE SITE VISIT.
Type or Print: Additional property owner sheet can be obtained online at www.co.thurston.wrz.us/permittin�or copy obtained
Jrom the Permit Assistant Center.
Property Owner(s): Justman Trustee
Mailing Address: 7 �
City: � State: Zip Code: 7
Phone#: , � � � '�j���' E Fa�c#:
Cell#: " E-mail:
Signature:*���,��� �.,,�.����-� Date: � �
n �
Applicant(if different than owner): Land 1evelo ment Consultants Inc �P R [�� /r s
Mailing Address:14201 NE 200th Street#1000
City: Woodinville State: WA Zip Code: 98072
Phone#: E'�i��� Ext. Fax#: (425)482-2893
Cell#: � ` f��7 E-mail: RCardoza(u�ldccorp.com
a
Signature:* ' Date: � �j
Point of Contact: Rick Cardoza
Mailing Address: 14201 NE 200th Street#1000
CitX: Woodinville State: WA Zip Code: 98072
Phone#: T(�25.}596�1�'Gl Ext. Fax#: (425)482-2893
Cell#: � r�"� � 1�� E-mail: RCardoza(a�ldccorp.com
Signature:* Date: �� C �
Revised�-25-12 Form No,ME���1
1
� 'Thurston County Permit Assistance Center
"' Master Application
Page 3 of 3
BRIEF DESCRIPTION OF PROJECT PROPOSAL ,
_,.,_. __.,.._.,_.tl.�._.__�_ ._�..�.�___,_.v.._.�n_...,.._.tl.e__r..�._ .�.��_�.__..._ ...�..m...._.._ r._ . _.�..
�a�ien of addinonal wireless panel antennas on existing telecom monopole. �� ��C-1 �f� ��:
�'��R�A (c��� e�f ,��' J� '�i e� � �
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BILLING INVOICES
T'he base application fee charged at the time of application covers base hours listed on the fee schedule. When the base
hours by a Department aze used,a monthly billing invoice will be generated for additional hours at the hourly rate listed
on the fee schedule. Should review of the project exceed the base hours allotted,billing invoices shall be mailed to:
�Owner 0 Applicant 0 Point of Contact
*Application is hereby made for a permit or permits to authorize the activities described herein. I certify that I am familiar
with the information contained in the application and that to the best of my knowledge and belief,such information is true,
complete,and accurate. I further certify that I possess the authority to undertake the proposed activities. I hereby grant to the
agencies to which this application i�made or forwarded,the right to enter the above-described location to inspect the proposed,
in-progress or completed work. I agree to start work onty after all necessary permit�iapprovals have been received.
Revised 7-25-12 Form No.MA001
:°7
� `� �������� Thurston County Resource Stewardship
�������
: � ,�: 2000 Lalceridge Dr. S.W.Olympia,WA 98502
;��`
(360)786-5490/(360)754-2939(Fax)
TDD Line(360)754-2933
Email:permitn,co.thurston.wa.us
���.Q�����-� www.co.thurston.wa.us/nermittine
��� Supplemental Application
SPECIAL USE
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13 107596 ZM THURSTO
Permit Type: Special Use Permit RECE��UNTY
Sub Type: WCF Calocation �D
"'°"`Ty�: 'JUN -3 2013
site: 11247 MORRIS RD SE YELM WA 98597
Assessor Property ID: 227304.'i0400 ; PERMIT ASStSTqN N�.E�
Applicant:Rick Cardoza/Land Development Consultants Inc CE CE
Owner: JUSTMAN FAMILY LLC r
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Intake b :
This a lication form cannot be submitted alone. In addition to this form,a com lete a licati acka e includes:
A�ppLcan# � s� F �o ` :� ��� ` �.y 4 `.` ` 5ta�'f Use ��
SUBMTTTA�,CHEC�LIST
::Use.. = ; .
�
_ , � ��
�. . ��� , ;
F ;. � _ . : ._. ;`; ..; �_Oinl. ,�
x Master a lication. ❑
A licable A lication fees. ❑
X Site lan. Refer to the a licable a lication checklist for the re uired number of ma co ies. 0
❑ A lication checklist. ❑
� Environmental Review SEPA , if re uired. ❑
Critical Area Administrative Review(required only if SEPA is not required and critical areas affect ❑
the ro e
� Special reports/plans(may include landscape plan,parking plan,engineered drainage plan,wetland ❑
delineation re ort, eotechnical re ort or other
ZONING JiJRISDICTION �Rural County ❑Lacey UGA ❑Tumwater UGA 0 Olympia UGA
Zoning Thurston County
TYPE OF APPLICATI�N(Check the applicable boxes)
❑ Hearing Examiner Special Use—Name of Project
�Mine/Asphalt Plant 5 Year Review ❑Mine/Asphalt Plant(new or expanded) �Temporary Use
0 Wireless Communication Facility ❑Day Care Centers and Nursery Schools �Extension of Time
❑Public Facilities/School ❑Expansion of a Nonconforming Use �Kennel 11 +dogs
�Home Based Industry,Type of Use
�Other(describe)
0 Administrative Special Use—Name of Project
0 Home Occupation,Type of Occupation
Co-location of wireless facility
_: Expansion of a Nonconforming Use(less than 5%in County,less than 25%in Olympia UGA)
�Extension of Time
�Temporary Use
�Other(describe)
Form No. SA039
Thurston County Resource Stewardship
Supplemental Applicarion for Special Use
Page 2 of 8
UTILITIES: ' � �� h / /�
Water Supply: ! ' �� " l �P '� G a �v`
Ezisting: �Single Family well �Two party well �Group B Well �Public Water System
Name of public water system:
Proposed: �Single Family well �Two Party well �Group B Well �Public Water System
Name of public water system:
Is water system located/proposed onsite? If no,provide tax parcel number of property the water system is
located or proposed on
Are there any off-site water supplies within 200 feet of the property? �Yes �No
How was this verified?
Sewage Disposal: N��
Ezisting: �Single Family Septic System 0 Community Septic System(Serves more than one home)
0 Public Utility Name of Public Utility
Proposed: �Single Family Septic Systems �Community Septic System
�Public Utility Name of Public Utility
Are the test holes dug? �Yes 0 No If No, explain
Is sewage system located/proposed onsite?Select One If no,provide t�parcel number of property the system is located
or proposed on
ACCESS:
❑x Existing �New OPrivate Road ❑Public Road
Name of road or street from which access is or will be gained Morris Road
How many other parcels ha�e access by this road?�!' l� / Cn �(�_e S`� .
Include vacant Parcels
CRITICAL AREAS:
Water on or within 300' of property: Ox None ❑Salt ❑River/Creek ❑Lake/Pond/Flood Zone ❑Wetland 0 Ditch
Name of water body:
Has the property ever flooded? 0 No �Do not know �Yes,when? (If yes,show area on site plan)
Slopes greater then 30%? 0 Yes �No
Are there other Critical Areas?(e.g. oak trees,eagle's nest,high ground water, etc.) 0 Yes 0 No
If yes,describe:
Revised 6-20-11 Form No. SA039
. , ,
Thurston County Resource Stewardship
Supplemental Application for Special Use
Page 3 of 8
ADDITIONAL PROJECT INFORMATION
Questions 1-13 must be completed for all project proposals.
1. What are the hours of operation? 24 hours a day �� �
2. What are the days of operation? Seven Days a week �/{�G `'
�Monday 0 Tuesday �Wednesday �Thursday OFriday �Saturday Ox Sunday
3. What is the total number of employees engaged in the business on this site? �
4. What is the total number of employees who reside off the property? �
5. Does the owner/operator of the proposed business reside on the property where the business is located?
0 Yes D No
6. Are customers expected to visit the site? �Yes �x No If no,skip to No. 8
7. What is the avera e number of vehicles visiting the site? per day per week l�� �� �
8. Are parking spaces being provided? �Yes �No If yes,how many N1� ✓���
9. Will this proposal generate noise��Yes ❑x No If yes,descnbe below the noise that will be generated
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10. Will there be any outside storage of materials or equipment?�Yes �No If yes,describe below in detail
what will be stored outside
11. Are any vehicles involved in the business:�Yes x❑No If yes,list the type of vehicle and how many
���_____ _�....�.._,_..��.__,.�.�.��..�...�..��.��.�._.�.�. _..�.��.._ _..�...�.._ w_.�..� �
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12. Is a sign proposed? ❑Yes „ 0 No If yes,how many� What is the square footage of each sign?
13. Is the use proposed within an accessory structure? �Yes 0 No If yes,what is the square footage of the
accessory structure?
Revised 6-20-11 Form No. SA039
,
Thurston County Resource Stewardship
Supplemental Application for Special Use
Page 4 of 8
Questions 14—36 shall only be completed if they apply to the project proposal. Check the not applicable boz for the
sections that do not apply.
NON-RESIDENTIAL USES-❑X Not Applicable
14. What is the gross square footage of e�usting non-residential buildings?
15. What is the gross squaze footage of proposed non-residential buildings?
16. What is the square footage of eausting imperviow area? Impervious area means
pavement(compacted gravel,asphalt and concrete),roofs,revetments,or any other man-made surface which
substantially impedes the infiltration of precipitation.
17. What is the total square footage of impervious area after the finished project?
DAY CARE CENTER or NURSERY SCHOOL-0 Not Applicable
18. Are you proposing a Day Care Center or Nursery School? Q Yes ❑No If no,proceed to question 22
19. What is the maximum number of students you are proposing?
20. What is the estimated m�imum expected vehicular trips generated?
21. How are these vehicular trips distributed by mode and time of day?
NONCONFORMING USE-0 Not Applicable
22. Are you converting one nonconforming use to another or enlarging a nonconforming use over 5%? ❑Yes �No
If no,proceed to question 29
23. What is the present(or previous if not occupied)use of the structure? Explain below:
24. What date was the structure last in use for the above operation?
25. When was the structure first occupied by the present use or similar use? If similar use,please describe
26. What provisions have been made to safeguard the adjoining properties against any detrimental effects that might
result from establishing the proposed use? Explain below:
Revised 6-20-I 1 Form No. SA039
Thurston County Resource Stewardship
Supplemental Application for Special Use
Page 5 of 8
27. For conversions only,indicate why the design of the structure housing the existing nonconforming use precludes
its use for any of the uses permitted in this zoning district. Explain below:
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28. For conversions only,how will the proposed use be more compatible with the permitted uses of the zoning district
than the existing use?
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Community Club,Private Club,Fraternal Organization,Church,Nursing or Convalescent Homes,
Public Utilities,Radio and Television Transmitting and Receiving Towers,Riding Stables,Riding
Academies,Veterinary Clinics and Hospitals-❑Not Applicable
29. Are you proposing one of the uses listed above? 0 Yes 0 No If no,proceed to question 32.
30. What provisions have been made to make the development compatible with the appearance and character of the
surroundmg neighborhood� Explam below
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'The proposed antennas will atch the ap earance and character of existing tenna fp on the tower. /"��/��� n� �
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31. For wireless communication facilities—submit information that shows a need or demand for the facility in the
proposed location and provide information on alternative locations considered. The information being submitted
sha11 reference question 29.
HOME OCCUPATION-❑X Not Applicable
32. Are you proposing a home occupation?�Yes ❑No If yes, answer the following questions.
33. Will there be exterior structural alternations of the primary residence in order to accommodate the home
occupation?�Yes �No If yes, explain
34. What is the square footage of the total building area on the property that will be devoted to the home
occupation?
35. Is the home occupation the type in which classes will be held or instruction given? �Yes ONo
If yes,explain
36. Will all activity related to the conduct of business be conducted within an enclosed structure? ❑Yes ONo
If no, explain
Revi�d 6-20-11 Form No. SA039
l , e
Thurston County Resource Stewardship
Supplemental Application for Special Use
Page 6 of 8
SPECIAL USE PERMIT
SUPPLEMENTAL AND SITE PLAN REQUIREMENT CHECKLIST
Please complete the appropriate checklist:
The application shall contain andlor address the following requirements in a clear,accurate and intelligible form.Submit the
appropriate checklist with your application. Check the box for each item addressed. Provide an explanation for any
unchecked item.
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` pUse,_, �' . ' �D1���TY.�:�,`�' YT�E�.SP�+� ��F,..�,SE �EmR���HECK�IST ��*���n��"��
� 1. T'he project site must be identified in the field by posting an identification sign visible � �
from the access road and by flagging the property corners and the center of the
driveway/road access location. The purpose of the sign is for project identification
rather than public notification. The sign and flagging aze provided by Thurston County
and can be obtained at the Permit Assistance Center.
� 2. A narrative summary of all uses and activities proposed on-site, including types of �
residential andlor non-residential uses.
Q3. Twelve(12) 11"x 17"or 8 %2"X 11",copies of the map. The map shall be drawn to a �
standard engineer scale and include the following:
� a. The property boundaries and property boundary dimensions of the entire property. �
� b. The location and height of all exisring and proposed structures, including,but not �
limited to,mobile homes,houses,sheds,gazages,barns,fences,culverts,bridges,
stora e tanks,retainin walls,decks and orches.
� c. Setback distances from all property lines (or road easements) to a11 existing and �
ro osed buildin s.
� d. The location of all existing and proposed wells, septic tanks, drainfields, reserve �
areas.
� e. All means,existing and proposed,vehicular and pedestrian ingress and egress to and �
from the site,including driveways,streets,fire access roads,including existing and
ro osed road names and existin coun and state ri t of wa .
� f. Identify areas to be cleared,graded,filled,excavated or otherwise disturbed. �
� g. The location of any e�usting critical areas or buffers affecting the site,both on-site �
and on adjacent properties,including but not limited to shorelines,wetlands,streams,
flood zones, stee slo es,hi h oundwater and s ecial habitats.
� h. Topographic information for the entire property based on available County two(2) �
foot contour ma s.
� i. The location and size of all parking and outside storage areas. �
� j. If proposing a kennel,the location of where the dogs will be housed and the type and �
height of existing and proposed fencing.
� k. All existing vegetation proposed to remain onsite and all proposed landscaping, �
includin location, e and hei t.
� 1. Vicinity sketch showing the relationship of the proposed development to major roads �
and hi wa s.
� m. Directions to the site. �
� n. A north arrow,map scale,datum,date, site address and directions to the site. �
Revised 6-20-11 Form No. SA039
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