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Home My WebLink AboutJARPA - SHX Application AGENCYUSE ONLY Agency Reference.#: Date Received: Other. JARPA FORM (tor use in Wastwpton State) PLEASE TYPE OR PRINT IN BLUE OR BLACK INK Based on the preceding checklist, 1 am sending copies of this application to the following: (check all that apply) (—j Local Government for shoreline; [—]Substantial Development ❑ Conditional Use IN Variance ❑ Exemption; or, if applicable ❑ Floodplain Management ❑ Critical Areas Ordinance OWashington Department of Fish and Wildlife for HPA Washington Department of Ecology for. ❑ Approval to Allow Temporary Exceedance of Water Quality Standards; ❑ 401 Water Quality Certification Nationwide Permits O Washington Department of Natural Resources for. ❑ Aquatic Resources Use Authorization Notification O Corps of Engineers for. ❑ Section 404 ❑ Section 10 permit O Coast Guard for. ❑ Section 9 Bridge Permit — SWTION A-Use for all permits covered by this application. Be sure to also Complete Section C(ftnature Block)ti r all permit agp/k�tlons. - 1.APPLICANT TRIand Hideaway Park MAILING AOMSS 3005 125thAv. SE #2B.Bellevue, Wa. 98005 ATT: Sarah Seidel 1NORK 7 5P ONE J.Berry FAX# Warr agent is acting for the appllcant during the permit process, complete tit 2 AUTHORIZED AGENT MAILING ADDRESS P.O. Box 11477 Olympia,Wa. 98508 PHONEWORK 360-866-1608 HOW PHONE 3 0 943-6841 i r1EtAT1 PWW OF APPLICANT TO PROPERTY: O OWNER J PURCHASER O LESSEE O OTHER: l NAME,ADDRESS,AND PHONE NUMBER OF PROPERTY OWNER(S).OF OTHER THAN APPLICANT Island Hideaway Park Association I LOCATION(STREET ADDRESS,INCLUDING CITY.COUNTY AND ZIP CODE.WHERE PROPOSED ACTIVITY EXISTS OR WILL OCCUR) Sund Rd. Stretch Island �S11TER8OOY TRIBUTARY OF Pickering Passage Puget Sound a SECTION TOWNSHIP RANGE GOVERNMENT LOT SHORELINE DESIGNATION 3 08 21 01 ZONING DESIGNATION Park AX PARCEL NO: ONR STREAM TYPE.IF KNOWN 3 DESCRIBE THE CURRENT USE OF THE PROPERTY.AND STRUCTURES EXISTING ON THE IN ETI PROPERTY. IF ANY 'THIS PROPERTY.INDICATE MONTH AND YEAR OF COMPLNN. PORTION OF THE PROPOSED ACTIVITY IS ALREADY COMPLETED ON Park Association Failing steps to beach IS THE PROPERTY AGRICULTURAL LAND? O YES ARE YOU A USDA PROGRAM PARTICIPANT7 10 YES p 7a DESCRIBE THE PROPOSED WORK COMPLETE PLANS AND SPECIFICATIONS SHOULD BE PROVIDED FOR ALL WORK WATERWARD OF THE ORDINARY HIGH WATER MARK OR LIN INCLUDING TYPES OF EQUIPMENT TO BE USED. IF APPLYING FOR A SHORELINE PERMIT.DESCRIBE ALL WORK WITHIN AND BEYOND 200 FEET OF THE OROINARY HIGH WATER MARK ATTACH A SEPARATE SHEET IF ADDITIONAL SPACE IS NEEDED. Remove existing steps to beach and construct in exact footprint new wooden stairway Erom top of slope to bulkhead at beach All construction debries disposed of upland see attached pland 7b. DESCRIBE THE PURPOSE OF THE PROPOSED WORK Saftty for Park Association members and family 7t DESCRIBE THE POTENTIAL IMPACTS TO CHARACTERISTIC USES OF THE WATER BODY. THESE USES MAY*KXUDE FISH AND AQUATIC RECREATION.M W AESTHETICS. IDENTIFY PROPOSED ACTIONS TO AVOID.MINIMIZE.AND MITIGATE DETRIMENTAL IMPACTS,AND PROVIDE WILIER PROTECTION WATER SUPPLY, AQUATIC LIFE. PROPER PROTECTION OF FISH AND. none PREPARATION OF DRAWINGS: SEE APPENDIX A-SAMPLE DRAVNNGS AND CHECKLIST FOR COMPLETING THE DRAWINGS. ONE SET OF ORA3/NAL OR 0000 QUALl7Y fta"%D X=U DRAWTI 1=MUST SE ATTACK= NOTE APPLICANTS ARE ENCOUR/GEO TO SLM W PHOTOGRAPHS OF THE PROJECT BRE,BUT THESE 00 NOT SUBSTITUTE FOR ORAWOM 7 CORPS OIF ENQfNEERS AND COAST GUANO IEEQIjgRE DRA*WIGS ON 8-1/2 X 11 MNCH SNEEM LAROER OTHE PR 5 CT SITE. E.BUT THESE E 0 NOT SUBSTITUTE Aooflcslion Pmw 2 of 4 9.WILL THE SROJECT BE CONSTRUCTED IN STAGES? O YES )ONO PROPOSED STARTING DATE: as soon as all permits available ESTIMATED DURATION OF ACTIVITY: 30 days from starttzig e 9.CHECK IF ANY STRUCTURES WILL BE PLACED: p WATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE FOR FRESH OR TIDAL WATERS;AND/OR O WATERWARD OF MEAN HIGH WATER LINE IN TIDAL WATERS 1Q WILL FILL MATERIAL(ROCK Fkl.BULKHEAD,PILINGS OR OTHER MATERIAL)BE PLACED: O WATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE FOR FRESH WATERS? IF YES.VOLUME(CUBIC YARDS) /AREA (ACRES) O WATERWARD OF THE MEAN HIGHER HIGH WATER FOR TIDAL WATERS? IF YES.VOLUME(CUBIC YARDS) /AREA (ACRES) 11.WILL MATERIAL BE PLACED IN WETLANDS? ❑YES ❑NO IF YES: A IMPACTED AREA IN ACRES: t HAS A DELINEATION BEEN COMPLETED? IF YES.PLEASE SUBMIT WITH APPLICATION. O YES O NO , HAS A WETLAND REPORT BEEN PREPARED? E YES.PLEASE SUBMIT WITH APPLICATION. ❑YFS ❑NO i TYPE AND COMPOSITION"FILL MATERIAL(E.a.SAND.ETC.): MATERIAL SOURCE: f IST ALL SOIL SERIES(TYPE OF SOIL)LOCATED AT THE PROJECT SITE.a INDICATE IF THEY ARE ON THE COUNTrS LIST OF HYDRIC SOILS.SOILS INFORMATION CAN BE ED FROM THE NATURAL RESOURCES CONSERVATION SERVICE(NRCSr . 1 .2 PROPOSED ACTIVITY CAUSE FLOODING OR DRAINING OF WETLANDS? ❑YES O NO i S.IMPACTED AREA IS ACRES. *EXCAVATION OR DREDGING BE REQUIRED IN WATER OR WETLANDS? O YES O NO B: ILUME: (CUBIC YARDS)/AREA (ACRES) IMPOSITION OF MATERIAL TO BE REMOVED: 1• IPOSAL SIZE FOR EXCAVATED MATERIAL' THOD OF OREDGINQ YTHER APPLICATIONS.APPROVALS.OR CERTIFICATIONS FROM OTHER FEDERAL,STATE OR LOCAL AGENCIES FOR ANY 9TRUCTURES.CONSTRUCTION,DISCHARGES.OR CTMTIES DESCRIBED IN THE APPLICATION(I.E..PRELIMINARY PLAT APPROVAL.HEALTH DWMICT APPROVAL.BUILDING PERMIT.$EPA REVIEW.FERC LICENSE.FOREST ES APPLICATION.*rc.) ALSO INDICATE WHETHER WORK HAS BEEN COMPLETED AND INDICATE ALL EXISTING WORK ON DRAWINGS. TYPE OF APPROVAL ISSUING AGENCY IDENTIFICATION NO. DATE OF APPLICATION DATE APPROVED COMPLETED? H AGENCY: agnnn��q PA DECISION: ISEPA DECISION DATE: NY AGENCY DENIED APPROVAL FOR THE ACTIVITY DESCRIBED HEREIN OR FOR ANY ACTIVITY DIRECTLY RELATED TO THE ACTMTY DESCRIBED 4? 0 YES KI NO IF YES. EXPLAIN: 1 j ApplaNn Page 3 of 4 SECTION B-Use for Shoreline and Corps of Engineers pen*s gayw S TOTAL COST OF PROJECT. THIS MEANS THE FAIN MARKET VALUE OF THE PROJECT,INCLUDING MATERIALS,LABOR,MACHINE RENTALS,ETC. r 7.LOCAL GOVERNMENT WITH JURISDICTION: Mason County Planning S.FOR CORPS.COAST GUARD,AND DNR PERMITS,PROVIDE NAMES,ADDRESSES,AND TELEPHONE NUMBERS OF ADJOINING PROPERTY OWNERS.LESSEES.ETC.. PLEASE NOTE: SHORELINE MANAGEMENT COMPLIANCE MAY REQUIRE ADDITIONAL NOTICE—CONSULT YOUR LOCAL GOVERNMENT. NAME ADDRESS PHONE NUMBER SECTION C- This section MUST be completed for any permit covered by this application. 19.APPLCATION 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 THIS 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 IS MADE,THE RIGHT TO ENTER THE ABOVE-DESCRIBED LOCATION TO INSPECT THE PROPOSED,IN-PROGRESS OR COMPLETED WORK. I AGKETO START I NORK ONLY AFTER ALL NECESSARY PERMITS HAVE BEEN RECEIVED. S RE OF APPLnkNT OR AUTHORIZED A 014, • ATE 1 HEREBY DESIGNATE TO ACT AS MY AGENT IN MATTERS RELATED APPLICATION MUST SIGN E PERMIT. FOR P IT(S} I UNDERSTAND THAT IF A FEDERAL PERMIT IS ISSUED, OL TUBE OF APPLICANT C� DATE / SIGNATURE OF LANDOWNER(EXCEPT PUBLIC ENTITY LANDOWNERS.E.G.DNR) TE THIS APPLICATION MUST BE SIGNED BY THE APPLICANT AND THE AGENT,IF AN AUTHORIZED AGENT IS DESIGNATED. 1e U.S.C;10M provides Mat Whoever,in any msnrw w"Ma jurisdiction of any depsrlment or a mats W faa«makes any false,rsxMlous,or kwx dwv statements oragerocY aT Ma united states krawMply talsifiee,oonaals,«oovea up by any hick sesame,or device Nalslne1K«elwy,Slap be Mud not mares Man$10.000 Oro«makes or uses any falee wr"ar doaarant knowirq same 10 oontrn any f1bbe,fditm e,«Ga xkderu �Pdsoned not more Man 5 yap«bah CO• MPLEED t3 (LIICAL OFFICIrt..' .: Nature of the extsfing shoreline (Desrxibe type of shoreline, such:::as marine,streattt� lake,tagoDn rtfarsll . y. a. typA Of:iieaCh.SUCK iiS'aCCr �9r 8wampr flood. etlon erosion high bank;. �`atYTl,C duce. tzsater#al sum&sttd,mud; lock nPrap: and.exEent and tl -of bulkheading,.if any.)> B. In.the event that any of the r 9 proposed bulildin s or structures will exceed a height of:forty five feet above the average.grade Level indicate the a pproximate location:Of and number-of residential units; existing a d potentials that w�[ Have vie as flbsicucted w' C. If the application involves a conditional use or variance, set forth in full that portion the master program which provides that the proposed.use may be a conditional use, or, in the case of a variance, from which the variance is being>sougtit Fors a"AgenClas we EqualY and employers .For AcdW employe . needs,please Contact the approprhte apenoY from Appenft a.