HomeMy WebLinkAboutPlace MFG Home - MEP Application - 7/7/1997 PERMIT NO.:
DATE RECEIVED:
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
INTERIM RESOURCE ORDINANCE (Chapter 17.01 MCC)
411 N. 5TH Street/P.O. Box 578,Shelton,Wa 98584
ENVIRONMENTAL PERMIT APPLICATION
MASON ENVIRONMENTAL PERMIT ❑ CONDITIONAL USE ❑ VARIANCE
The purpose of the Interim 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 FEE:$110.00
1. Owner: W ILLIAwl :�-o L1clS.0 Owner Mailing Address: 116o'b a$ 'N?Z-. Ail. t.
Site Address:A,6nag56 uESr is CtL cp, City: LA/<r SriF✓ears State: W A Zip: 98a!5'6
City: State: Zip: Lien/Title Holder: (A«14&1 �0i-WSC�
Phone:( ) Fire District# Address: 5A,"cz R s A,30vE
City: State: Zip:
2. Parcel Number:3-43o3 - So - o/u 3k Legal description:,AYock 13Eo,:.H Su�3DiV sw,,L
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Parcel Size: 178.7o X 13 S yy X I-A, 3 l X 5,3 .3 q
-5 W N
3. Directions to Site:
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4. State what sections required a permit:
Long-Term Commercial Forest, Chapter 17.10.060; Inholding Lands, Chapter 17.01.062;
Mineral Resource Lands , Chapter 17.01.066; Wetlands, 17.01.070; Critical Aquifer Recharge,
Chapter 17.01.080; _Aquatic Manaaement Areas, Chapter 17.01.110; Frequently Flooded Areas,
Chapter 17.01.090; Landslide Hazard Areas, 17.01.100; Seismic Hazard Areas, Chapter 17.01.102;
Erosion Hazard Areas, 17.01.104.
5. Identify current use of property with existing improvements:
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6. Identify and describe the proposed project, including the type of materials to be used, construction methods,
principal dimensions, and other pertinent information (Attach additional sheets if needed):
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7. Any water on or adjacent to property: Saltwater Lake River Pond Wetland
Seasonal Runoff�_Other °g,�E
8. Will there be an alteration of a wetland and/or wetland vegetation area? Yes No_ 2L
9. If septic is located on project site, include records.
Connect to septic?X Community Septic? Public Water Supply?�_ Well?
10. Type of Job: New d Alt Repair Demolition Other
This permit is granted pursuant to the Interim Resource Ordinance(Chapter 17.01 MCC) and nothing in this permit shall
excuse the applicant from compliance with any other federal, state, or local statutes, ordinances, or regulations applicable
to this project, but not inconsistent with the Interim Resource Ordinance. The permit maybe rescinded pursuant to the
event the permittee fails to comply with the conditions of this ordinance.
Show the following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Stucture Setbacks Driveways
Water Lines Shorelines
Drainage Plans Topography
Septic System Wells Indicate Directional by (N,S,E,W,etc.)
Proposed Improvements Easements in relation to plot plan
Name of Flanking Street
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APPLICANT TO DRAW TOPOGRAPH BELOW:
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