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HomeMy WebLinkAboutMEP2016-00035 - MEP Application - 9/13/2016 MASON ENVIRONMENTAL PERMIT($630 or$380 w/other permit) Mason County Permit Center Use: ❑ CONDITIONAL USE($1520) MEP 2,0 1 - 00035 f3 HABITAT MANAGEMENT PLAN REVIEW($445) Date Rcvd ZOI(a RECEIVED MASON COUNTY SEP 13 2016 DEPARTMENT OF COMMUNITY DEVELOPMENT 615 W. Alder Street Mason County Resource Ordinance(Chapter 17.01 MCC) ENVIRONMENTAL PERMIT APPLICATION The purpose of the Resource Ordinance is to protect Mason County's natural resource lands and critical areas and is under the authority of Chapters 36.32, 36.70A,39.34, 58.17, 76.09, 84.33, 84.34 and 90.58 RCW. PLEASE PRINT 1. PROPERTY OWNER Name: 5VvC-&j t 4417e-AjQA t4,4WKIP$ Mailing Address: Nj5 /4je*2-rEl 5f4026 P_V,/ B�L j4/�y lljA 99,ozg Work Phone: Email Address: 713QQ�, Home/ e 1 Phon (953) ZSS iZ3 Fax#: tf an agent is acting.for the property owner during the permit process, complete#2. 2. AUTHORIZED AGENT Name: 6956 /' ,01l oi4-N — A10P26A-yN — 3C/t'4L7- 17�944e55 a�ik 6 z . Mailing Address: 14OZ03 V,+7-6�5 L1qhu67 A- ,, 9POEv yf6ve-7j vl w,'09 72 )W z- Work Phone: C?(,U) g�o/ — �tl q0 Email Address: 6A6:�v/Y/JQ&, b- at Home/Cell Phone: C Fax# 3. PROJECT SITE pp�� n Site Address: t Z'700 N NU27-N 5�� G0// Parcel #: ?j�23 L - �D- 00o3S Legal Description: �A V�N d'S! 13 Directions to Site: rl&; 15 ELP�qi2/ TA-,A 0w V 300 tf 04-7 S� WC-5 1- 70 APDPL.,t5,55 . 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. r :unit I)eve'UC :;m PAC ft 11 E' ,:;c` i (42 ReViWd Rene 201i1 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 /VFish&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: LUUp-6V 6LOPW — do E7Xc5T-r1o&' l lud�l`L�>VE�'►/IEi�T� 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): w©uz_n I-I/,/� — 6Wj!5 cge9veA-e.- o!F Bcl12-7- ZwI7�V I.)PV292 FLc VIL 4f2W6Z 6ZE auto�w sc 3 s�zE 3� c� ob x Z z�`., �v5 /J D T 15 AV6 ' GQJIPE, 7. Describe why the action requiring this permit cannot be avoided. U NPAMEV Z uA)WAQr-o .5- FP,_oPC-1Z7-1V IUoR) 8. Will there be an alteration of a wetland and/or wetland vegetation area(circle one)? Yes No 9. Identify any surface water on or adjacent to property(circle one): Saltwater Lake dgiD Pond Wetland <j rain�Ditc 10. Identify existing septic/sewer connection(circle one): If septic is located onp//fit site, include records. Connected to Septic Connected to Community Septic N M 11. Identify existing water supply(circle one): Public Water Supply Well 11. Type of Job(circle one): ew Add Alteration Repair Demolition Other: Print�Nmie �� , L` Signature Date