HomeMy WebLinkAboutGRD94-0001 - GRD Permit / Conditions - 1/13/1994 GRID b\
MASON COUNTY
LAND MODIFICATION PERMIT
Grading, Excavation, Fill, Slopes, Drainage
Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#1 Owner �)� �� L��� Phone# �ZR;R9 Fire District#
Site Address f VS/L l� Y /K [l�C' G,�� city (g9j=:D2,y St Zip sl
4;Qwner Address City St Zip
Describe Work
#2 Contractor Name Contractor Reg #
Address Expiration Date
City Cr �e� St _Zip �� S " Phone #
'#3 Engineer's Name Phone #
Address City St Zip
#4, Parcel No
Legal Description
#5 Number of cubic yards to be excavated:
Number of cubic yards to be filled: 3 SUS
Number of cubic yards to be graded:
46 Will this be a balanced cut and fill entirely within the site?
Yes No --"<-
If No: Will fill be brought on site? Yes L^>I— No /J
Where does imported fill originate from?
Does fill contain any potentially hazardous materials?
Yes No �- D EGEWE
s� �r -V--0 'Dom CE—
Sc c L's - J A N 13 1994
'7 Will excavated materials be taken off site? Yes No �- GfNERAL SERVICES
If Yes: Where will excavated materials be taken?
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#8 BrV describe ex sting terrain, vegetation, nd improveruents on subje t site? d 1 q
#9 Total size of area to be cleared acres/sq ft
Size of area to be cleared on slopes over 10% AC/SF
#10 Has a soils report been completed on the subject site? �J
If yes, include copy with application.
#11 Is the subject site within 200 feet of a designated shoreline
#12 Does the subject site contain any of the following features?
River Lake �/--Wetlands Saltwater
Slope greater than 15% Soft compressible soils
Seasonal Runoff None
#13 Will the proposed land surface modification change the points
where storm water or groundwater enters or exits the site?
#14 Will the proposed land surface modification change the quality,
quantity, or velocity of storm water/groundwater? (�
#15 What methods, if any, will be utilized to minimize erosion and
possible sedimentation into nearby waters during and after
construction? AO I/1
#16 Will this land modification result in the redirection of any surface
water runoff onto adjacent properties? Z e�) 9�!:
#17 Will surface or subsurface runoff be collected or controlled by
interceptors, curtain drains, or other water collection devices
once this land modification has been completed? 140
#18 Will the land be replanted upon completion? Z119
If yes, with what types of plants?
#19 Will this modification result in slopes steeper than those currently
on the site? If so, how steep?
i
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
1 Proposed Improvements Easements Indicate Direction aLtay (N, S, E, W)
Name of Flanking Street in relati6r plot plan
Name of Fronting Street
"APPLICANT TO DRAW SITE P OW
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW