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PERMIT NO.
DATE RECIEVED
y MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
INTERIM RESOURCE ORDINANCE(Chapter 17.01 MCC)
Courthouse Annex III,425 W. Cedar/P.O.Box 578, Shelton, WA 98584,427-9670/1-800-562-5628
ENVIRONMENTAL PERMIT APPLICATION
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,and 90.58 RCW.
PLEASE PRINT
#1 Owner Mery Settle Phone# 360-426-9763
Site Address W 1401 Deegan Road E. Fire District #
City Shelton State WA Zip 98584
Owner Mailing Address same as above
City State Zip
Lien/Title Holder
Address
City State Zip
#2 Parcel No. 42025-43-00100 Legal Description See attachment
Parcel Size approximately 10 acres
#3 Directions to site(please attach map) Highway 101 to No. Shelton exit: east under highway to first road on south
(Deegan Road E.)
#4 Indicate what sections require a permit:
Long-term Commercial Forest, Chapter 17.10.060; Inholding Lands, Chapter 17.01.062
Mineral Resource Lands, Chapter 17.01.066;_✓_Wetlands, Chapter 17.01.070; Critical Aquifer
Recharge, Chapter 17.01.080; Aquatic Mangement Areas, Chapter 17.01.110
Geologic hazard area: Frequently Flooded Areas, Chapter 17.01.090; Landslide Hazard Areas,
Chapter 17.01.100; Seismic Hazard Areas, Chapter 17.01.102; Erosion Hazard Areas, Chapter
17.01.104.
#5 Identify current use of property with existing improvements: Current use as single family residence with historic
landfill material.
#6 Identify and descirbe the proposed project, including the type of materials to be used,construction methods,
principal dimensions, and other pertinent information(Attach additional sheets if needed.)
Proposed restoration of filled wetland and development of RV Park-see restoration plan for details of fill
removal.
#7 Any water on or adjacent to property: Saltwater Lake River Pond
✓ Wetland ✓ Seasonal Runoff Other
#8 Will there be an alteration of a wetland and/or wetland vegetation area? _✓_Yes No
Restored wetland proposed.
#9 If septic is located on project site, include records. Connect to septic? Community septic?
Public Water Supply? _✓_Well?
#10 Type of job: New _✓_Add Alt _✓_Repair Demolition Other
This permit is granted pursuant to the Interim Resource Ordinance P g P (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 may be rescinded
pursuant to the event the permittee fails to comply with the conditions of this ordinance.
8271 app/cmk 1
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DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
COMMENTS
Planning:
Environmental Health:
Building Plan Review:
Occupancy Group:
Firc Marshal:
Other:
Conditions: FEES
TOTAL FEES
Accepted by:
Date:
P
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. Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks ; Driveways
Water Lines Shorelines
Drainage Plan Topography.
Septic System Wells Indicate Directional by (N, S, E, W)
Proposed Improvements Easements Name of Flanking Street in relation to plot plan.
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