HomeMy WebLinkAboutMEP2012-00004 Picnic Area - MEP Application - 2/29/2012 MASON ENVIRONMENTAL PERMIT($630 or$380 w/other permit) Mason County Permit Center Use:
❑ CONDITIONAL USE($1520) MEP
❑ HABITAT MANAGEMENT PLAN REVIEW($445) Date Rcvd 2-2-`I -1
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: MGlsm
Mailing Address: 41' 1 1 V 5! S
Work Phone: �-1 _ Email Address:
Home/Cell Phone: S LTI �� Fax#:
If an agent is acting for the property owner during the permit process, complete#2.
2.AUTHORIZED AGENT 45
Name:
Mailing Address:
Work Phone: Email Address:
Home/Cell Phone: Fax#
3. PROJECT SITE
Site Address:
Parcel#: -00 - �0011D Legal Description:
Directions to Site: 0�\Jrvk v,,� 15�L 3 ' R,�`.� �,,,, S� Svc 5I'. I"ry e,,
\S e^-
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.
l:\Co;umunity Development'.PACAM P Page 1 of 2 Revised.tune 2010
'4. State which section requires permit:
r ❑ 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
❑ Wetlands,Chapter 17.01.070
5. Identify current use of the property with existing improvements:
JIr iS R --- K 1►c R, j14 LAAk
TwArupvt~'
�Wc9 C \GV-'►L S'k
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):
�J
c� l.3( .
CotptLL
7. Describe why the action requiring this permit cannot be avoided.
-ko re., A 4S W on
8. Will there be an alteration of a wetland and/or wetland vegetation area(circle one)? Yes o�
9. Identify any surface water on or adjacent to property(circle one):
Saltwater 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 (:N(\ ( F�
11. Identify existing water supply(circle one): Public Water Supply Well '-ytJ A
11. Type of Job(circle one):
ew Add Alteration Repair Demolition Other:
Print Name Sign to a Date
L\Conimunily UevelopmeniTAOMEP Page 2 f 2 Revised.tune 20It?
I�
4
E s
i VVV
� PiGRJF GD.t�IC,�E�e p;.�7L,
TA�� �� VA/AAL Y, �IV/s T-rA
SH L.TER F
I
V
W
f _ _
VA/A L K, EV�Ve AG0.hkGR
Tc6 _..
y , GI-j c vq
1, 10 x 20
sH2L.TER
4
-- - __ -• T
All
10 x 20`
Imo----�'---�
sH �: LTEF,
WA L �-