HomeMy WebLinkAboutMEP2018-00020 BLD2018-00315 - MEP Application - 7/24/2018 f ..
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MASON COUNTY Mason County Permit Center Use:
COMMUNITY SERVICES MEP_ZD IS - WOW
Building,Planning,Environmental Health,Community Health Date Rcvd 1—Z 1 g
615 W.Alder St.-Bldg.8,Shelton,Wa 98584
Phone:(360)427-9670 ext.352♦Fax:(360)427-7798
XMASON ENVIRONMENTAL PERMIT:$115
-MASON ENVIRONMENTAL PERMIT WITH HABITAT MANAGEMENT PLAN:$1500
❑ CONDITIONAL USE: $2000
Mason County Resource Ordinance(Chapter 8.52 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: K'e 0 I N e t, F L
tcy 40,
Mailing Address: , 4-6cC,O VV
Work Phone: Email Address:
Home/Cell Phone: Fax#:
If an agent is acting for the property oivner during the permit process,complete#2.
2.AUTHORIZED AGENT
Name:
Mailing Address: ACA LA
Work Phone: D j Email Ad ss: 'I vl�i0 Cv i
Home/Cell Phone: Fax#
3.PROJECT SITE
Site Address:
Parcel#: _ Legal Description:
Z2
Directions to Site:
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.
Rev.March 1,2018
4. State which section requires permit:
❑ Long Term Commercial Forest,Chapter 8.52.060 ❑ Frequently Flooded Areas,Chapter 8.52.130
❑ Mineral Resource Lands,Chapter 8.52.090 ❑ Geologically Hazardous Areas,Chapter 8.52.140
❑ Critical Aquifer Recharge Areas,Chapter 8.52.120 ❑ Seismic Hazard Areas,Chapter 8.52.150.
❑ Erosion Hazard Area,Chapter 8.52.160 ❑ Fish&Wildlife Habitat Conservation Areas,Chapter
❑ In-Holding Lands,Chapter 8.52.070 8.52.170
❑ Wetlands,Chapter 8.52.110
5. Identify current use of the property with existing improvements:
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):
c 'I - 11
44 MD L y y1_n1k 64yp beey1 �1 i IW-
7. Describe why the action requiring this permit cannot be avoided.
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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 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 Conununity Se c
11. Identify existing water supply(circle one): Publi_Water_ Well
11. Type of Job(circle one):
(-New Add Alteration Repair Demolition Other:
rent Name Signature Date
Rev.March 1,2018
l t1d
LINDSEYZ LANDSCAPE & EXCAVATION LINDSLE846ML 360-490-5765
b.
446
Summary of work to be completed:
Clean up and remove all weeds that are present in the planting areas, plant native trees and
bushes listed below.
Pacific Dog wood
Vine Maple
Pacific Rhododendron
Evergreen Huckleberry
Salal
Several types of Ferns APPROVED
MASON COUNTY DCD PLANNING
SITE PLAN REQUIREDTC BE ON SITE
CHANGES SUBJECT TO Ar
Any questions feel free to call By Date. Zsy? -Regards, L r✓i p 0 0 ZJl
Danielle Skeeters-Lindsey /
Lindseyz Landscape F1 Excavation
360-490-5765
RECEIVED
JUN U 1 M8
615 W Alder Street