HomeMy WebLinkAboutGRD2018-00001 - GRD Application - 3/17/2018 i
MASON COUNTY PERMIT NO ra
,: G I
\� DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING.PLANNING•FIRE MARSHAL
- WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
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 ( rading Permit)
OWNER INFORMATION: CONTRAC OR 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: ZIP:
PHONE: 360-427-9670 x652 CELL: 360-490-0396 _ PHONE: CELL:
EMAIL: bsteppnn co.mason.wa.us EMAIL :
L&I REG# EXP.
PARCEL INFORMATION:
ER) 42004-40-60000 FIRE DISTRICT 16
LEGAL DESCRIPTION(ABBREVIATED) : T 20N R 4W Section 4 SE 1/4 ction
SITE ADDRESS 501 W Eells Hill Rd Shelton WA 98584 CITY Shelton,WA 98584
DIRECTIONS TO SITE ADDRESS TakeUSI01toHwyIO2 and o west. Turn north 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 CUTTING ❑ 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 s rmwater pond. All other parts of the project
consist of im rovements on exist�iing 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: No
DOES FILL CONTAIN POTENTIAL HAZARDOUS MATERIALS? - N/A YES❑ NO❑
HAS A SOILS REPORT BEEN COMPLETED ON SITE?IF YES,INCLUDE A OPY. YES ❑ NO
WILL PROPSAL RESULT IN REDIRECTION OF ANY SURFACE WATER RUNOFF? YES❑ NO R
WILL WORK ALTER WHERE STORMWATER OF GROUND WATER ENTERS OR EXISTS THE SITE? YES ❑ NO
WILL QUALITY,QUANTITY OR VELOCITY OF STORM/GROUND WATER BE ALTERED? YES ❑ NOR
WILL THE RUNOFF BE COLLETED/CONTROLLED BY INTERCEPTORS,CURTAIN RAINS OR OTHER DEVICES. YES R NO ❑
WILL THE LAND BE REPLANTED UPON COMPLETION? YES N NO ❑
WILL THE PROPOSAL RESULT IN SLOPES STEEPER THAN THOSE CURRENTLY ON SITE? YES ❑ NO N
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 Pevocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or contractor. 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 r presents that the
information provided is accurate and grants employees of Mason County access to the above described property a d structure(s)for
review and inspection.This permit/application becomes null&void if work or authori d construction is not comme c4 within 180
days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY EANS OF
INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATI N.
X 12/2 17
Signature of Applicant Date
X_ Bart Stepp, Deputy Director/Utilities &Waste OWNER REPRESENTATIVE/CONTRACTOR
Print Name (CIRCLE TO INDICATE)