HomeMy WebLinkAboutSHX2023-00043 BLD2023-01335 - SHX Application - 11/6/2023 RECEIVED:
f MASON COUNTY RECEIVED
. COMMUNITY SERVICES NOV 0 6 2023
\ Building,Planning,Environmental Health,Community Health
\ _ 615 W.Alder St.—Bldg.8,Shelton,Wa 98584 615 W. Alder ,Srt'reet �} ,
Phone:(360)427-9670 ext.352 ♦ Fax:(360)427-7798 PERMIT NO.;r 44iC;2,L- &C 2i�P!
SHORELINE PERMIT APPLICATION
SHORELINE PERMITS
CONDITIONAL USE* SUBSTANTIAL DEVELOPMENT
VARIANCE* EXEMPTION
ACCESSORY DWELLING UNIT*
The Washington State Shoreline Management Act (RCW 90.58) requires that substantial developments within designated
shorelines of the state comply with its administrative procedures (WAC 173-14) and the provisions of the Mason County
Shoreline Management Master Program. The purpose of this Act and local program is to protect the state's shoreline
resources. The program requires that substantial development (any development of which the total cost or fair market
value exceeds $7,047.00 or materially interferes with the normal public use of the water or shorelines of the State be
reviewed with the goals, polices, and performance standards established in the Master Program.
Answer all questions completely. Attach any additional information that may further describe the proposed development.
Incomplete applications will be returned.
*Shoreline Variances and Conditional uses require public hearings and have additional pages that shall be
attached to this application.
APPLICANT: Richard Wall
ADDRESS: 4417 SW 109th St
(street)
Seattle WA 98146
(city) (state) (zip)
TELEPHONE: 206-852-5698
(home) (business)
AUTHORIZED REPRESENTATIVE: Integrated NW Construction,LLC(Caralyn Valdeman,GM and Sarah Kupers,PM)
ADDRESS: PO Box 1008
(street)
Hoodsport WA 98548
(city) (state) (zip)
TELEPHONE: Main: (253)888-5314 Sarah:(360)968-3441 Caralyn:(206)310-4239
PROPERTY DESCRIPTION:
General location (include property address, water body and associated wetlands—identify the name of the shoreline):
Rev. Nov. 30, 2021
101 N Marine View Ln, Hoodsport adjacent to Lake Cushman
Include all parcel numbers: Projects located in open water areas, away from land shall provide latitude/longitude.
42333-51-02911
w
OWNERSHIP:
Contract (identify)Applicant Owner Lessee 7 Identi Purchaser Other
Owner: Tacoma Power
3628 S 35th St Tacoma WA 98409
(street) (city) (state) (zip)
DEVELOPMENT DESCRIPTON:
Development proposal (identify and describe the proposed project, including the type of materials to be used, construction
methods, principle dimensions, and other pertinent information):
Demo, remove, and dispose of existing shoreline structures (bulkhead, pier, and ramp); construct new
bulkhead, pier, and floating dock; install two new pre-fab aluminum ramps; bulkhead will be constructed using
driven steel piles and Alaskan yellow cedar(AYC)face boards; pier will be constructed using driven steel piles,
grating, and AYC lumber; floating dock will be constructed the same plus encased Styrofoam billets
Existing Use(identify current use of property with exist improvements):
Existing SFR is a vacation home; existing shoreline structures allow for water access and boat
moorage; existing shed allows for storage; existing retaining walls prevent hillside slippage
Reason for requesting development:
The existing structures are at the end of their useful life and need to be replaced.
Estimated Fair Market Value of Project to Closest$1,000: $242k
The Applicant shall provide, at a minimum, the following information:
a. SITE PLAN -drawn to scale and including:
i. The boundary of the parcel(s) of land upon which the development is proposed:
ii. The ordinary high water mark (OHWM). This may be an approximate location provided, that for any development
where a determination of consistency with the applicable regulations requires a precise location of the OHWM the
mark shall be located precisely and the biological and hydrological basis for the location as indicated on the plans
shall be included in the development plan. Where the OHWM is neither adjacent to or within the boundary of the
project, the plan shall indicate the distance and direction to the nearest OHWM of a shoreline,
iii. Where appropriate, the proposed land contours using five-foot intervals in water area and ten-foot intervals on
areas landward of OHWM, if development involves grading, cutting, filling, or other alteration of land contours;
iv. The dimensions and location of existing structures which will be maintained,
v. The dimensions and locations of proposed structures, parking and landscaping;
vi. The location of proposed utilities, such as sewer, septic tanks and drain fields, water, gas and electricity,
vii.The location, source, composition, and volume of fill material,
viii. The location, composition and volume of any extracted materials, and proposed disposal area;
b. CROSS SECTION, drawn to scale including:
i. The existing ground elevations;
ii. The proposed ground elevations;
iii. The location and height of existing structures;
iv. The location and height of proposed structures,
V. The OHWM.
c. VICINITY MAP,including:
i. The location of subject parcel using natural points of reference (roads, state highways, prominent landmarks,
etc.).
ii. If the development involves the removal of any soils by dredging or otherwise, identify the proposed disposal
site on the map. If disposal site is beyond the confines of the vicinity map, provide another vicinity map
showing the precise location of the disposal site and its distance to nearest city or town.
iii. On the map, or separately, give a brief narrative description of the vicinity of the proposed project including
identification of the adjacent uses, structures and improvements, intensity of development and physical
characteristics.
d. ADJACENT LANDOWNERS. Provide names and mailing addresses of all real property owners within 300
feet of property line boundaries where development is proposed as mailing labels or pre-addressed
envelopes.
ACKOWLEDGEMENT:
I hereby re, to t of my knowledge and belief, the forgoing information and all attached information is true and
correct
11/2/23
(App scant or Authorized Representative) (date)
Publication Cost Agreement
Publication cost is the responsibility of the applicant. Final permit processing
will not occur until advertising fees have been paid to the newspaper by the
applicant. The Shelton-Mason County Journal will bill the applicant directly.
Billing Address:
ST
SEA TL , WA 81 RICHARDJWAif L@COMCAST.NET
SEATTLE, WA 98146 Email:
Phone: (206) 852-5698
I / WE understand that I / WE must sign and date the attached
acknowledgment indicating and that I / WE understand that is MY / OUR
responsibility. I / WE must submit the signed page as part of application in
order for it to be considered as complete.
Signature of Property Owner Date Print Name
OR
11/2/23 CARAILYN VALDEMAN
ignature of Applicant Date Print Name
NOV Docu lope ID:76C64103-CAEA-4F14-AC41-44E7830F7473 NO° O 6 2PI
74
AGENCY USE ONLY Mr
Army
ees�g Date received:
WASHINGTON STATE o
Seatt?e 6:e�iit
Joint Aquatic Resources Permit
Agency reference#
Application (DARPA) Form' 2
f ,
USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. i Tax Parcel#(s):
r
t �
Part 1—Project Identification ______________________________:
1. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development)
Wall Wilson Dock Replacement
Part 2—Applicant
2a. Name (Last, First, Middle)
Wall, Richard & Wilson, William
2b. Organization(If applicable)
Wilson Revocable Living Trust
2c. Mailing Address (Street or PO Box)
4117 SW 109th
2d, City, State, Zip
Seattle, WA 98146
2e. Phone(1) 2f. Phone(2) 2g. Fax 2h. E-mail
206-852-5681 richardjwall@comcast.net
Part 3—Authorized Agent or Contact
3a. Name (Last, First, Middle)
Valdeman, Caralyn
3b. Organization
Integrated NW Construction, LLC
3C. Mailing Address (Street or PO Box)
PO Box 1008
3d. City, State, Zip
Hoodsport, WA 98548
3e. Phone(1) 3f. Phone(2) 3g. Fax 3h. E-mail
253-888-5314 206-310-4239 caralyn@integratednwconstruction.com
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Part 4—Property Owner(s)
Contact information for people or organizations owning the property(ies) where the project will occur. Consider both
upland and aquatic ownership because the upland owners may not own the adjacent aquatic land.
�7X Same as applicant. (Skip to Part 5.)
Repair or maintenance activities on existing rights-of-way or easements. (Skip to Part 5.)
There are multiple upland property owners. Complete the section below and fill out JARPA Attachment A for
each additional property owner.
\ Your project is on Department of Natural Resources (DNR)-managed aquatic lands. If you don't know, contact
the DNR at (360) 902-1100 to determine aquatic land ownership. If yes, complete JARPA Attachment E to
apply for the Aquatic Use Authorization.
4a. Name (Last, First, Middle)
4b. Organization (If applicable)
4c. Mailing Address (Street or PO Box)
4d. City, State, Zip
4e. Phone(1) i 0. Phone(2) 4g. Fax 4h. E-mail
Part 5—Project Location(s)
❑ There are multiple project locations. Complete the section below and use JARPA Attachment B
5a. Indicate the type of ownership of the property. (Check all that apply.)
❑ Private Federal ❑ Publicly owned (state, county, city, special districts like schools, ports, etc.)
❑ Tribal x Department of Natural Resources (DNR) — managed aquatic lands (Complete JARPA Attachment E)
5b. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5p.)
101 N Marine View Ln
5c. City, State, Zip(If the project is not in a city or town, provide the name of the nearest city or town.)
Hoodsport, WA 98548
5d. County
Mason
5e. Provide the section, township, and range for the project location.
'/4 Section Section Township Range
32 23N — — 4W
5f. Provide the latitude and longitude of the project location. Example:47.03922 N lat. I-122.89142 W long.
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47.441053 N, -123.217747 W
5g. List the tax parcel number(s) for the project location.
42333-51-02911
5h. Contact Information for all adjoining property owners. (if you need more space, use DARPA Attachment C.)
Name Mailing Address Tax Parcel # (if known)
N: Raine, Gordon & Gretchen 10135 Main Street 42333-51-02913
Bellevue, WA 98004
S: Hall Trse, Heidi P.O Box 805 42323-51-02912
Hoodsport, WA 98548
5i. List all wetlands on or adjacent to the project location. Gi
No wetlands
5j. List all waterbodies (other than wetlands) on or adjacent to the project location.
Lake Cushman
5k. Is any part of the project area within a 100-year floodplain?
X Yes ❑ No ❑ Don't know
51. Briefly describe the vegetation and habitat conditions on the property.
Deciduous and evergreen trees, shrubs, and bushes.
5m. Describe how the property is currently used
Residential
5n. Describe how the adjacent properties are currently used
Residential
5o. Describe the structures (above and below ground) on the property, their purpose(s) and current condition.
Residence, Dock
5p. Provide driving directions from the closest highway to the project location, and attach a map.
Directions from Shelton:
North on Us-101 N to Hoodsport (23 miles). Left onto N. Lake Cushman Rd (119) approximately 5.8 miles. Turn
left Marine View Drive, then right at the first hairpin turn. 101 Marine View Drive is on the left.
Part 6—Project Description
6a. Briefly summarize the overall project. You can provide more detail in 6b.
Remove existing bulkhead and shoreline structures. Construct a new bulkhead, pier, ramp, and float. Existing
structures consist of a 45.5 linear foot bulkhead, 16'1"x 154" pier (247.89 so, 18'6" x 1011" and 26'11" x
4'10.5" deck (333.63 so, 2'11" x 17'6" wooden ramp (not over water, 52.62 so. Proposed new construction will
consist of a new 67 linear foot bulkhead at the toe of the slope, 6'x22' pier (132 so, 3'x12' ramp (36 so, and
8'x16' float (128 so. The new 8' x 16' float will have greater than 60% light passage using flow-through grating
and be supported by 4 galvanized steel pilings. The new 6'x22' pier will have 50% functional grating and be
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supported by 6 galvanized steel pilings. The aluminum ramp will have 60% light passage. Proposed new
deck, pier, ramp, and float construction will be reduced by 338.14 sf. The proposed new bulkhead will be
increased by 21.5 linear feet.
61b. Describe the purpose of the project and why you want or need to perform it.
The existing bulkhead is failing and at risk if not replaced. Replace aging dock used for recreation moorage,
boating, and water-related activities.
6c. Indicate the project category. (Check all that apply)
❑ Commercial ® Residential ❑ Institutional ❑ Transportation ® Recreational
❑ Maintenance ❑ Environmental Enhancement
6d. Indicate the major elements of your project. (check all that apply) [neicJ
❑ Aquaculture ❑ Culvert ❑ Float ❑ Retaining Wall
❑ Bank Stabilization ❑ Dam /Weir ❑ Floating Home (upland)
❑ Boat House ❑ Dike/ Levee/Jetty ❑ Geotechnical Survey ❑ Road
ElBoat Launch El Ditch ❑ El Scientific
Clearing Measurement Device
❑ Boat Lift ® Dock/ Pier ❑ Marina / Moorage ❑ Stairs
❑ Bridge ❑ Dredging ❑ Mining ❑ Stormwater facility
® Bulkhead ❑ Fence ❑ Outfall Structure ❑ Swimming Pool
❑ Buoy ❑ Ferry Terminal ❑ Piling/Dolphin ❑ Utility Line
❑ Channel Modification ❑ Fishway ❑ Raft
❑ Other:
6e. Describe how you plan to construct each project element checked in 6d. Include specific construction
methods and equipment to be used.
• Identify where each element will occur in relation to the nearest waterbody. Indicate which activities are within the 100-year floodplain.
-Remove existing bulkhead, pier, and ramp
-Construct new 57 linear foot bulkhead at the tow of the slope with two 5' return wing-walls
-Install new pier, ramp and float
6f. What are the anticipated start and end dates for project construction? (Month/Year)
• If the project will be constructed in phases or stages,use DARPA Attachment D to list the start and end dates of each phase or stage.
Start Date: February 2024 End Date: April 2024 ❑ See JARPA Attachment D
6g. Fair market value of the project, including materials, labor, machine rentals, etc.
$242k
6h. Will any portion of the project receive federal funding? If yes, list each agency providing funds.
❑ Yes 71 No ❑ Don't know
Part 7—Wetlands: Impacts and Mitigation
❑ Check here if there are wetlands or wetland buffers on or adjacent to the project area. (If none,skip to Part 8.)
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7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands.
❑x Not applicable
7b. Will the project impact wetlands?
❑ Yes ❑x No ❑ Don't know
7c. Will the project impact wetland buffers?
❑ Yes E No ❑ Don't know
7d. Has a wetland delineation report been prepared? If Yes,submit the report,including data sheets,with the JARPA package.
Yes ❑x No
7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating
System? If Yes, submit the wetland rating forms and figures with the DARPA package.
Yes ❑ No ❑ Don't know Not applicable
7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? if Yes, submit the
Ian with the JARPA package and answer 7 . If No or Not applicable,explain below why a mitigation plan should not be required.
❑ Yes Z No '— Don't know
7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was
used to design the plan.
7h. Use the table below to list the type and rating of each wetland impacted, the extent and duration of the
impact, and the type and amount of mitigation proposed. Or if you are submitting a mitigation plan with a
similar table, you can state (below) where we can find this information in the plan.
Activity (fill, Wetland Wetland type Impact area Duratio Proposed Wetland
drain, excavate, Name' and rating (sq. ft. or n of mitigation mitigation area
flood, etc.) category2 Acres) impact3 type' (sq. ft. or acres)
If no official name for the wetland exists, create a unique name(such as"Wetland 1"). The name should be consistent with other project documents.
such as a wetland delineation report.
Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System. Provide the wetland rating forms
with the JARPA package.
3 Indicate the days,months or years the wetland will be measurably impacted by the activity.Enter"permanent"if applicable.
Creation C), Re-establishment/Rehabilitation R ,Enhancement E . Preservation P ,Mitigation Bank/In-lieu fee B
Page number(s) for similar information in the mitigation plan, if available:
7i. For all filling activities identified in 7h, describe the source and nature of the fill material, the amount in
cubic yards that will be used, and how and where it will be placed into the wetland.
7j. For all excavating activities identified in 7h, describe the excavation method, type and amount of material in
cubic yards you will remove, and where the material will be disposed.
Part 8—Waterbodies (other than wetlands): Impacts and Mitigation
In Part 8, "waterbodies" refers to non-wetland waterbodies. (See Part 7 for information related to wetlands.)
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M Check here if there are waterbodies on or adjacent to the project area. (If there are none, skip to Part 9.)
8a. Describe how the project is designed to avoid and minimize adverse impacts to the aquatic environment.
❑ Not applicable
V
The new pier and float will have at least 50% grating with at least 60% light passage. All existed treated
lumber will be removed from the shoreline. The ramp will be fully grated.
8b. Will your project impact a waterbody or the area around a waterbody?
M Yes ❑ No
8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland
waterbodies? if Yes, submit the plan with the DARPA package and answer 8d. If No,or Not applicable,explain below why a
mitigation plan should not be required.
® Yes ❑ No ❑ Don't know
8d. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was
used to design the plan. If you already completed 7g you do not need to restate your answer here.
See attached HMP for the required planting plan.
8e. Summarize impact(s) to each waterbody in the table below.
Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or
dredge, fill, pile name' location of impact3 (cubic yards) to be linear ft.) of
drive, etc.) placed in or removed waterbody
from waterbody directly affected
If no official name for the waterbody exists,create a unique name(such as"Stream 1")The name should be consistent with other documents
provided.
z Indicate whether the impact will occur in or adjacent to the waterbody. If adjacent,provide the distance between the impact and the waterbody and
indicate whether the impact will occur within the 100-year flood plain.
3 Indicate the days,months or years the waterbody will be measurably impacted by the work. Enter"permanent"if applicable.
8f. For all activities identified in 8e, describe the source and nature of the fill material, amount (in cubic yards)
you will use, and how and where it will be placed into the waterbody.
No fill will be installed
8g. For all excavating or dredging activities identified in 8e, describe the method for excavating or dredging,
type and amount of material you will remove, and where the material will be disposed.
No excavating or dredging.
Part 9—Additional Information
Any additional information you can provide helps the reviewer(s) understand your project. Complete as much of
this section as you can.
9a. If you have already worked with any government agencies on this project, list them below.
Agency Name ; Contact Name Phone Most Recent
Date of Contact
Mason County 360-427-9670
WA State Dept Fish &Wildlife 360-480-3510
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9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 of this DARPA on the Washington
-n
Department of Ecology's 303(d) List? if Yes,list the parameter(s)below. If you don't know, use Washington Department
of Ecology's Water Quality Assessment tools at: httr)://www,ecy.wa.gov/g)rograMI/�NVg/303d/,
Yes ❑x No
9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in?
• Go to http:/icfpub.epa.gov/surf/locate/index.cfm to help identify the HUC.
17110017
9d. What Water Resource Inventory Area Number(WRIA#) is the project in?
• Go to http,/Iwww.ecy.wa.gov/waterlwria/index.htmi to find the WRIA#.
16
9e. Will the in-water construction work comply with the State of Washington water quality standards for
turbidity?
• Go to ^ c /www.ecv.wa.gov/orograms/vig/swos/criteria.html for the standards.
X Yes ❑ No ❑ Not applicable
9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline
environment designation?
• For more information, go to ntt ://www.ec v.wa. ov/ r rams/sea/sma/laws rules/173-2 /211 desi nations.htmi.
❑ Urban ❑ Natural X Aquatic ❑ Conservancy ❑ Other:
9g. What is the Washington Department of Natural Resources Water Type?
• Go to http:/twww.dnr.wa.gov,`forest-practices-water-typing for the Forest Practices Water Typing System,
Ex Shoreline ❑ Fish ❑ Non-Fish Perennial ❑ Non-Fish Seasonal
9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater
manual? If No, provide the name of the manual your project is designed to meet.
❑x Yes ❑ No
Name of manual: 2019 Stormwater Management Manual for Western Washington
9i. Does the project site have known contaminated sediment? If Yes, please describe below.
❑ Yes ❑ No
9j. If you know what the property was used for in the past, describe below.
Residential
9k. Has a cultural resource (archaeological) survey been performed on the project area?
• If Yes, attach it to your DARPA package.
Yes X No
91. Name each species listed under the federal Endangered Species Act that occurs in the vicinity of the
project area or might be affected by the proposed work.
Marbled Murrelet, Northern Spotted Owl
9m. Name each species or habitat on the Washington Department of Fish and Wildlife's Priority Habitats and
Species List that might be affected by the proposed work.
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No affect by proposed work.
Part 10—SEPA Compliance and Permits
Use the resources and checklist below to identify the permits you are applying for.
• Online Project Questionnaire at http://apr)s.oria.wa.gov/opas/.
• Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or helpCa-oria.wa.gov.
• For a list of addresses to send your JARPA to, click on agency addresses for completed DARPA.
10a. Compliance with the State Environmental Policy Act (SEPA). (Check all that apply.)
• For more information about SEPA, go to www.ecy.wa.gov/programs/sea/sepa/e-review.htm1.
® A copy of the SEPA determination or letter of exemption is included with this application.
❑ A SEPA determination is pending with Mason County. The expected decision date is Fall 2023
❑ I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 10b.)
❑ This project is exempt (choose type of exemption below).
❑ Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt?
❑ Other:
❑ SEPA is pre-empted by federal law.
10b. Indicate the permits you are applying for. (Check all that apply.)
a
LOCAL GOVE!, M
Local Government Shoreline permits:
❑ Substantial Development ❑ Conditional Use ❑ Variance
® Shoreline Exemption Type (explain):
Other City/County permits:
❑ Floodplain Development Permit ❑ Critical Areas Ordinance
\ . .� WWI
\
Washington Department of Fish and Wildlife:
® Hydraulic Project Approval (HPA) ❑ Fish Habitat Enhancement Exemption—Attach Exemption Form
❑ My project is exempt from the application fee. (Check appropriate exemption):
❑ HPA processing is conducted by applicant funded WDFW staff.
Agreement#
❑ Mineral prospecting and mining
❑ Project occurs on farm and
(Attach a copy of current land use classification recorded with the county auditor, or other proof of current land use)
❑ Project
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Washington Department of Natural Resources:
❑ Aquatic Use Authorization
Complete JARPA Attachment E and submit a check for$25 payable to the Washington Department of Natural Resources.
Washington Department of Ecology:
❑ Section 401 Water Quality Certification
11"E I %M'%i Illy/ i " FEDERAL GOVERNMENT
United States Department of the Army permits (U.S. Army Corps of Engineers):
❑ Section 404 (discharges into waters of the U.S.) ❑ Section 10 (work in navigable waters)
United States Coast Guard permits:
❑ Private Aids to Navigation (for non-bridge projects)
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Part 11—Authorizing Signatures
Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form,
project plans, photos, etc.
11 a. Applicant Signature (required)
I certify that to the best of my knowledge and belief, the information provided in this application is true, complete,
and accurate. I also certify that I have the authority to carry out the proposed activities, and I agree to start work
only after I have received all necessary permits.
I hereby au orizoe agent named in Part 3 of this application to act on my behalf in matters related to this
application. x (initial)
By initialing here, I state that I have the authority to grant access to the property. I also give my consent to the
permitting agencies entering the property where the project is located to inspect the project site or any work
related to the project. j L w " (initial)
Richard Wall William Wilson � --�1" 10/16/2023 FE_int
10/16/2023
Applicant Printed Name App1 c Signature 2' to
11 b. Authorized Agent Signature
I certify that to the best of my knowledge and belief, the information provided in this application is true, complete,
and accurate. I also certify that I have the authority to carry out the proposed activities and I"agree to start work
only after all necessary permits have been issued.
Caralyn Valdeman DocuSigned by:
10/16/2023
Authorized Agent Printed Name _t"dDXg&A Signature Date
11 c. Property Owner Signature (if not applicant)
Not required if project is on existing rights-of-way or easements (provide copy of easement with JARPA).
I consent to the permitting agencies entering the property where the project is located to inspect the project site
or any work. These inspections shall occur at reasonable times and, if practical, with prior notice to the
landowner.
Property Owner Printed Name Property Owner Signature Date
18 U.S.0§1001 provides that:Whoever, in any manner within the jurisdiction of any department or agency of the United States knowingly
falsifies, conceals, or covers up by any trick, scheme, or device a material fact or makes any false,fictitious, or fraudulent statements or
representations or makes or uses any false writing or document knowing same to contain any false, fictitious, or fraudulent statement or
entry, shall be fined not more than$10,000 or imprisoned not more than 5 years or both.
If you require this document in another format, contact the Governor's Office for Regulatory Innovation and As!jstance(ORIA)at(800)
917-0043. People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call(877)833-
6341. ORIA publication number: ORIA-16-011 rev.09/2016
ORIA-16-011 Page 10 of 10
AFFIDAVIT OF POSTING NOTICE
STATE OF WASHINGTON )
) ss:
COUNTY OF MASON )
RE: (Parcel#or Address of Site): (0 19 Mq Ln, 140d L4 4
I, Julie Cheney , Planner for Mason County, do hereby certify that I have posted 1 copies
of the attached:
Notice of Application
On this L,il day of `ru� , 20j in c2 conspicuous
places as follows:
o One at The Site
o One at The Mason County Building One's Public Bulletin Board [411 N 51h St—Shelton,WA]
o One at
In witness whereof, the party has signed this Affidavit of Posting Notice this L�� day of
10 yv6t ni , 20� .
Signed by Julie Cheney
Mason County Community Services Department
615 W. Alder St—Shelton, WA 98584
Subscribed and sworn before me this 441" day of �p 1,�r 144 H
20 _, 1 certify that �Vl1P CC,�lQh�e� signed this document.
`````11111111nI►Hy���'i
��.�` G 'I�•' ���i,� NOTARY PUBLIC in and for the State of Washington,
.aNZ .�i •. �i A
Printed Name of Notary: reSA V, : &t 2
• fAOTAAy ± ,^^
residing at: I •IAS0✓% r ,✓vim
PUBLIC
•••• �••� ;� My Commission Expires: I ,�0S/.
11 11
Community Development
(Permit Assistance Center/Building/Planning)
MASON COUNTY
615 W.Alder Street—Shelton,WA 98584
COMMUNITY DEVELOPMENT 36masoncoun Ext.352
masoncountywa.sov
Permit Assistance Center, Building,Planning
Notice of Application
Administrative Shoreline Substantial Development Permit
Notice is hereby given that Richard Wall, who is the applicant for the following proposal, has filed an
application for an administrative Shoreline Substantial Development Permit(SHR2023-00026)to
construct a larger replacement dock and bulkhead on Lake Cushman. Other permit requirements include
but are not limited to Mason County building permit and WDFW HPA permit. A Habitat Management
Plan has been prepared for the project.
Location: 101 N Marine View Ln, Hoodsport,WA
Parcel Number:42333-51-02911
Zoning: RR5 (Rural Residential 5)
Date of Application&Complete Application: December 27, 2023
Notice of Application/Complete Application:January 4, 2024
Public Comment Deadline: February 4,2024
Notice of Decision will be issued: on or after February 4, 2024
A SEPA DNS was issued on January 4, 2024, with a comment period extending to January 18, 2024.
A public hearing will not be held regarding the proposed project, however written comments may be
submitted to the Planning Department during this 30-day shoreline public comment period by February
4,2024.To view application materials, submit comments or questions, or view the decision after the
comment period, contact:
Mail and Office Location Email and Phone
Julie Cheney, Planner JCheney@MasonCountyWA.gov
Mason County Community Development 360-427-9670 ext. 357
615 W. Alder St., Shelton,WA 98584
Following the public comment deadline, a copy of the decision will be forwarded to all parties of record
(only those who provided comment(s) during the 30-day public comment period), the applicant, Dept. of
Ecology, and Attorney General only.The referenced decision may also be viewed at the Planning
Department at the above address during normal business hours by interested parties or by contacting
the Planner listed above. Please note that there is a 14-day appeal period following the issuance date of
said decision.Timely appeals shall be filed with the Mason County Planning Department in accordance
with the requirements stipulated in MCC 15.09 and 15.11
A decision on these applications will be made within 120 days of the date of the complete application or
mutually agreed upon later date between Mason County and the applicant.
Posted: 1/3/2024