HomeMy WebLinkAboutGRD2018-00001 - GRD Application - 3/5/2018 &A�..
MASON COUNTY PERMIT NO . G I f t6 r
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING.PLANNING,FIRE MARSHAL
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
f Mason County Bldg.8, (360)275-4467 Belfair ext. 352
615 W.Alder Street,Shelton,WA 98584 (360)482-5269 Elma ext. 352
LAND MODIFICATION PERMIT (Grading Permit)
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: Mason County Public Works,attn:Bart Stepp NAME: To Be Determined
MAILING ADDRESS:100 W.Public Works Drive _ MAILING ADDRESS:
CITY: Shelton STATE: WA ZIP: 98584 CITY: STATE: IP:
PHONE: 360-427-9670 x652 CELL: 360-490-0396 _ PHONE: CELL:
EMAIL: bsteppAco.mason.wa.us EMAIL
L&I REG#
PARCEL INFORMATION:
PARCEL NUMBER(12 ER) 42004-40-60000 FIRE DISTRICT i 16
LEGAL DESCRIPTION(ABBREVIATED) : T 20N R 4W Section 4 SE 1/4 Section
SITE ADDRESS 501 W Eells Hill Rd,Shelton,WA 98584 CITY Sh Iton WA 98584
DIRECTIONS TO SITE ADDRESS Take US 101 to Hwy 102 and o west. Tu orth on Eells Hill Road and o 1/4 mile and
site will be on your left.
IS PROPERTY WITHIN 200 FT:
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF ❑ STREAM❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES X O❑
WILL TIMBER BE CUT AND SOLD IN PARCEL PREPARATION? YES ❑ NO X
TYPE OF JOB: EXCAVATION X FILLING ❑ GRADING X CLING ❑ OTHER X
TOTAL SIZE OF PARCEL 97.82_ACRES SIZE OF AREA TO BE EFFECTED 0.25 ACRES
ESTIMATED AMOUNT OF CUBIC YARDS 3,000
DOES THE SITE HAVE SLOPES 14%OR GREATER YES X NO❑
DESCRIBE SCOPE OF WORK Excavation of undeveloped ground for use as a slormwater pond. All other parts of the project
consist of improvements on exisii7n-g developed roads or structures to improve Tran er Station operations.
WILL FILL BE BROUGHT ON SITE? IF YES,SITE ADDRESS: No
WILL EXCAVATED MATERIAL BE TAKEN OFF SITE?IF YES,SITE ADDRESS: N
DOES FILL CONTAIN POTENTIAL HAZARDOUS MATERIALS? - N/A YES❑ NO❑
HAS A SOILS REPORT BEEN COMPLETED ON SITE?IF YES,INCLUDE A COPY. YES ❑ NO i2
WILL PROPSAL RESULT IN REDIRECTION OF ANY SURFACE WATER RUNOFF? YES ❑ NO Z
WILL WORK ALTER WHERE STORMWATER OF GROUND WATER ENTERS OR EXISTS THE SITE? YES❑ NO EJ
WILL QUALITY,QUANTITY OR VELOCITY OF STORM/GROUND WATER E ALTERED? YES❑ NO®
WILL THE RUNOFF BE COLLETED/CONTROLLED BY INTERCEPTORS,CURTAIN DRAINS OR OTHER DEVICES. YES Z NO❑
WILL THE LAND BE REPLANTED UPON COMPLETION? YES N NO❑
WILL THE PROPOSAL RESULT IN SLOPES STEEPER THAN THOSE C LY ON SITE? YES ❑ NON
IS THE SITE WITHIN 200 FT OF A DESIGNATED SHORELINE OR A WETLAND? YES❑ NON
OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit evocation.
Acknowledgement of such is by signature below. I declare that I am the owner,own legal representative,or cont actor. I further
declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary
parties,including any easement holder or parties of interest regarding this project.The owner or authorized agent rE presents that the
information provided is accurate and grants employees of Mason County access to the above described property ar d structure(s)for
review and inspection.This permit/application becomes null&void if work or authori d construction is not commeriped within 180
days or if construction work is suspended for a period of 180 days. PROOF OF CON INUATION OF WORK IS BY MEANS OF
INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL VALIDATE THE APPLICATION.
X- -7 n 12/2 17
Signature of Applicant Date
X Bart Stepp, Deputy Director/Utilities &Waste OWNERREPRESENTATIVE/CONTRACTOR
Print Name (CIRCLE TO INDICATE)
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