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HomeMy WebLinkAboutJARPA - SHX Application - 4/20/2000 c e JARPA FORM "a' dlor aa�Ha Waal�pbn SWA PLEASE TYPE OR PRMrr IN NJUE OR SLUR MHK Based on the pre sav cMoldlst,I wn awmkq copies of oft apptiodion to the mowing: (check M Thag.aiT�ply) Loots Howe MWIf for sherd m: ❑StH*mntlel Development ❑Conddonal Use ❑Vwknos ❑ETrorTVUm;or,if applicew MASON Country ❑FbedMsIn lVIanWnwt ❑Critical Areas Ordirmce WasllMlpton Oeparbno t of Fish and Wildlife for HPA W of Ecology for. Approval to Allow Temporary Exceedanoe of Water Quality StaMards ❑401 Water Quality Certifipdiop N&flw*de Pen*s ❑ Washington OeparbTmt of Natural Resources for.❑Aquatic Resources Use Authorization Notification Corps tcr: Section 404 o(Sedion 10 permit ❑ Coast Guard tor. Section 0 Permit SCCMN A-Visa for a#pwnft eovered by girls aAPpemtlo L Ste am Go also coalpdieb itiotlon C dune IWrwlp axorar>rp01Mf 1.APPUCANr MALMKHADDRESS WORK P►IOrE HiDrIE PHHOlaE FAX s '� aan avant is acfrtrg lb►tlfHap4pitcaM Ure Pe►a�lltP �. 2 AUTHORQED AGENT' I� MAKJNG ADDRESS VVM PHONE FAX• &RELATK*MW OF APPLICANT TO PROPEITY: OWNER O PURd1Asm O LE86� c OTHER: 4.NAME,ADDRESS,AND PHIONE NUMBER OF PROPERTY OwNER(s),fF OTHER TH M APPUC4M S.LOCATION(STREET ADOINUM INCLUM0 ON COUNN AND ZIP CODE;WHO PROPOa60 ACnVr1Y EXWTS OR WLL occulp /710" S- WATEIRSWY (AE-44E., TRIBl/f'OF AVGiFT ,SoVJV,0 85SA6-F-) Aloyz v4 SECTION TOWNSHIP RANGE GOVERNMENTLOT 4HORELI E DESIGNATION f 1� �raYT 1+ots t Of zoNr+GDEsIGHu►4roHI TAX PARCEL NO.: DNR STREAM TYPE,IF KNOVMN p AppWaftn Papa I or 4 €e 1+r all 1 MIY ORZIDNaF IROpOdt lAOVMiV*ALl%WpYCOA ON Rr N,��ry of I�'�plAc��eNT IN IMw!IOPEItTYAWOMLUAM LAND?O YES �NZ- ARE YOU A USDA PROGRAM PARTKXpANTT O YTB; 7-L I E THE PROPCOW WORK COMPLETE PL WS AID SPBOMCATIOM SHOULD BE PROVIDED FOR ALL WORK WATERWARO OF THE aRDWARY HIGH WATERMARK OR rX 1 6 mooP,EN wLlshl,�'.4JJ ® �� 7k OMClfaET1EiFtF� YMORK Tv t ep4 4 C,6 7W 7 E SAYIE �e�GAT/'OK �S T�',�E OR/G-IN,gL, Gil 7t OENILTt THE FOMEIiW }Fl3rIAITAL;F jto USES OF W WA THESE USMS MA1C tIDE F18F1 ANDAQUATIC LNE WA#Ot iMJAt TTY,WATER SUFPI.Y. ATFOFA anA INFO ibEiflfY PlIOPOSED ACnOFf f IMNIM AM M1116ATE DETRIAEMAL MS'ACT3.AMID PROVIDE PROPE�t PROT�1 f Rop©.SEA PROPER �iZoTE�T�{DiY' (�r9L�. Week SekR fl eol��+p�+ To /7.4son/ Covn7-3f S7-,gN,v.QPs. FMTEFARATpN OF WAWMV M APPE M A-SAMPLE DRAWN=AND p1ECK1 W FOR COWUTMfS TM ORAWNN6. ONE SETOFg1OMAlAL OR 0O010 QIJAtJ1 Y �EEOAiNM�Ms lIEA77ACMNLTc NOTE; APPUCANTTF ARE OCWVAWToSOW PHQMRAPHCOFTHEE s ,8U IMWAONOTAMMUTE FMONNIAMUW--pMMf�M� AIIApC1aA3fOtlAllllRL�O(AIO t ZMllifhXtlAlFCf fTi 4AR6EtQlMWMMSMA4tYlQRFQLINtODOY07//FR ABaFQEENE: l WLL 7HE PI�OJECi BB ODNSTIlUCTO)N STAOE87 E]YES)(NO PROPD.EgsrAmTNOMa�T� �s .Sco Iy �S P©s.5��C31.E E3TMMATtE006AMTTDNDFAC7MTY: � �/c c F!.allEpc rF AHY STRUC7UREE WLL eE FM/IDi� !r E O WATERWARO OF THE OM NIARY mH WATER MARK OR LINE F M FRESH OR TIDAL WATTm7ts,Amm O WATiRWAROOF THE MEAN H W WATER LNE N TTDAL WA"M M WLL FI.L MATENO�L fROOK, P4*KW OR OTFISt MATOtIAL)BE PLACED O WATEtWARD OF TIE ORDINARY HIGH WATER MARK OR UK FOR FRESH SH WATERV Vg,,V a FA YES;VCXt�IE K:UOC YAR08)JA" {M;REg O WAI"NAW Of,V*MEAN*IGHE R HAEH,WA?bt FOR WAL WATERS? `�O lye ems.YOLUME PJW YA" .gWA , (ACRES) T T.WILL MATENAL BE PLACED N WETLAM M + ®YEa's ©NO IMPACTED IF YES: / /1 A. AREA IN / �/ A ACRES: S,HAS A DELNEATTON BEEN COMPLETED?F YEs.PLEASE SLww Wrm APPWCATKw, OYES ONO' C.HAS A WETLAND REPORT BEEN PFIE PARES F YES,PLEASE SUBENT WTM APPLICItT10N. t]YES ONO O.TYPE AND OOMPOSTRON OF FAL MA 71stllAl O. SAND l8. .Encr E MATERIAL SOURCE: F.LNTT ALL SON-29RES(TYPE OF SOF4 LOCATO)AT TW FMEOJGCr UM i NMCATE IF THEY ARE ON THE;COUNTYS UST OF HYDRIC SOLS. SOLS NFORMATK N CAN BE OVANED FROM IM NATURAL RNOU N ODN/BRVATFDN S0MOE VIRM 12.WILL PROPOSEDACTMTYCAUIERAOONO Olt ORAWNG0FWETLANDS? �YEOz HO Appllmfw Pmp 2 of 4 FYI.NPACfW AMA W��AM= }' I&NAl NWAVATION OR ORON O W PSOLOW N WA10 ORWOL Igri V%M- A. r aooMPOwM1c��C�P''�i1'1iAMN:,7�(fi�RNir�pif�R - . Q OISPOSAL SRE FOR EWAVAIW MATERIAL O.METHOD OF OREOONO: U APP1IDVALRORONrtTfFICATGOlMaR+eR*gwLiOGAItGRr OR IrCIMiNN� QIMl118NTllNMMUCA'RC1N�.E,MM�Y/�!A'�N�YMAD M /rlR�l�1I11t+ PkA m m ys APPLfLY1T10i1 )ALGIO'NDICATf 1MS4fi�WORK FIRSNNlII L Nf510ATE ALL Moelf lft VMCJiUc Ofi VATrDS. TYPE OF APPROVAL ISSWNO AGENCY CoNT CATION NO. DATE OF APPLICATION DATE APPROVED COMPLETED? � >>EPA4l+AQARiDGGY SNI'/1ON71BIOft SEPAOECISI�NOA'�E: is. K"spy- � &W Wflu"O 'My REATW-fO"W WfflY I ❑Yft F YM.EXPLM: 1a *w ME 0A W�Wft%%%AX OF";ft iw.W iMM GitA1NG"A LABOR.MACHM MRA^ETC IlL pa IINN�a� .. 1�I�IN'��LIiIYRNI"iil�N��11�Ck��� `�1tMtLO�t+ FNOP�CiYOMYNHW.kt ,lE1C.PLEASE AQlif" PHONE NUMYER k See S'Hee 7- Appke"Paco 3 of 4 #E�"f10N C•. YAT be oompm"tar Say pslaa o w"h!►this N Ml1lE�ll I YMAtIB tAl �311f 111 11C1I161F1MM Aoiml�W -i� ..ION"" 11ATIAMFA �M110NCQlf1�IM�ili�iM�11M�IL�K>��9111Y�'�11�ItT]I�iYME�TO�MY #�i>i .a {'Ig�il�l" 1�'I�Itll�'MLfAR M11 •``s AOOIRIAIE 11�11�tEK�'1i�'#P 'REA101��{ '�/11aE �/YC�!# , 1 `I� ilY1MQ11FNBANM E91�1ID11`IRf11fl1�,1i1E1 }1f1 ?1lifNll13 1bMliME ,.,. WrC 1 AOfiM TO aIfMRT VYONfY AFRR ALL P HAVE B! #1 eIONATtIRE aF APP1.Kallff t]R DAIM 40 ' I ICY OESiGNATE TO=AS MY AGEW IP MATWU PAL A7W TO T6MB APPUMlMf4M PERANT(81; i iM�t,I WAW THAT IF A FWMA&PMW 0 WSM.I MUST SIGN THE PERM ' NATURE a4APPUCANT OATS ' arlwA PUBM EPO." E M MM DA APPCIG►TM�I+ j as;SK�NEI)arT11�APR Iwo 1HE A0 ►r,FAN IS�iSIONATEEL r. uua awAft+P��e�id a 4 wlaa.r. A::.4�rl�e�+hMla�Yrlpr�,rMt.�r'+r«r111rMMie.r 1 1i�1 MLtiNIMirwMi�;, Mtlw a nnteAel lest ax nnlss r1Y iMlylil-M�I!MF+M�rrr SMIMMMMQ4t�IU� i!�r�rr�`sMlNr >rwA/witrieNna�t oranby,abaN M rrwr net aeew w N /net nmw& tls yws or bW n y. r��tcN�M6gwlOppailMt�aMt/�1ANmM/MrAclbrl�tp�b�res +v+�w�ocenrnodlelfon m.ati pban oonf W"splPfob MWMY loot Apt xft& Appf sftn Palle.of 4