HomeMy WebLinkAboutMEP2011-00034 WADOT Sherwood Creek Bridge - MEP Application - 8/26/2011 0 MASON ENVIRONMENTAL PERMIT($630 or$380 w/other permit) Mason County Permit Center Use:
0 CONDITIONAL USE($1520) MEP 2.0 1 1 - �d
0 HABITAT MANAGEMENT PLAN REVIEW($445)
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MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Mason County Resource Ordinance(Chapter 17.01 MCC)
ENVIRONMENTAL PERMIT APPLICATION
The purpose of the Resource Ordinance is to protect Mason County's natural resource lands and critical areas and is
under the authority of Chapters 36.32,36.70A,39.34,58.17, 76.09, 84.33,84.34 and 90.58 RCW.
PLEASE PRINT
1.PROPERTY OWNER
Name: Washington State Department of Transportation
Mailing Address: See below
Work Phone: Email Address:
Home/Cell Phone: Fax#:
If an agent is acting for the property owner during the permit process, complete#2.
2.AUTHORIZED AGENT
Name: Jeff Sawyer, Olympic Region Environmental Manager
Mailing Address:PO Box 47417, Olympia, WA 98504
Work Phone:(360) 570-6701 Email Address:sawyerj@wsdot.wa.gov
Home/Cell Phone:(360) 790-9646 Fax#(360) 570-6697
3.PROJECT SITE
Site Address:
Parcel#: - - Legal Description:Sec. 20, T. 22 N, R. 1 W.
Directions to Site:
Project is located on SR 3 at milepost 20.36, 20.5 mi, N. of US 101.
Attach a site plan showing the following: Lot Dimensions,Flood Zones,Existing Structures,Fences,
Water Lines,Driveways,Drainage Plans,Shorelines,Septic System,Topography,Proposed
Improvements,Easements,North Arrow,and Scale. Also draw a separate topography diagram.
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4. State which section requires permit:
❑ Long Term Commercial Forest,Chapter 17.10.060 ❑ Frequently Flooded Areas,Chapter 17.01.090
❑ Mineral Resource Lands,Chapter 17.01.066 ❑ Landslide Hazard Area,Chapter 17.01.100
❑ Aquifer Recharge Area,Chapter 17.01.080 ❑ Seismic Hazard Areas,Chapter 17.01.102
❑ Erosion Hazard Area,Chapter 17.01.104 ❑ Fish&Wildlife Habitat Conservation Areas,Chapter
❑ In-Holding Lands,Chapter 17.01.062 17.01.110
B Wetlands,Chapter 17.01.070
5. Identify current use of the property with existing improvements:
Current use of the property is WSDOT right-of-way.
6. Identify and describe the proposed project, including the type of materials to be used,construction methods,
principle dimensions,and other pertinent information(attach additional sheets,if needed):
See JARPA application, Part 6a.
7. Describe why the action requiring this permit cannot be avoided.
Project will repair and prevent additional scour at the base of the bridge
piers of Bridge 003/015. The original protection is no longer present.
8. Will there be an alteration of a wetland and/or wetland vegetation area(circle one)? ge ) No
9. Identify any surface water on or adjacent to property(circle one):
Sa� ery, Lake Stream Pond Wetland Drainage Ditch
10. Identify existing septic/sewer connection(circle one): If septic is located on project site, include records.
Connected to Septic Connected to Community Septic XA
11. Identify existing water supply(circle one): Public Water Supply Well NoP1 e-
11. Type of Job(circle one):
New Add Alteration Repair Demolition Other:
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Print Name AgAature Date
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