HomeMy WebLinkAboutGRD98-0017 - GRD Permit / Conditions - 12/30/1998 7 2-5(D ydS S e per. tie?,w&1
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- OG MASON COUNTY l s11-3O
a , LAND MODIFICATION PERMIT
"69 1
-0-- 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
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#1 Owner Phone# 6-70di Fire District#
Site Address 30 og M7 t„7b, k)A C4 City (lnj4r> 6&o St tJ4 Zip9S33Z
Owner Address O 6.t �4' City U n Jo" St t.Jo+ Zip Go,7-Z
Describe Work /�� �': - /r C. t 1(7 —.� �ZF :�c
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#2 Contractor Name A Contractor Reg#
Address Expiration Date
City St Zip Phone#
#3 Engineer's Name / Phone#
Address City St Zip
#4 Parcel No. 3 Z 2
Legal Description
#5 Number of cubic yards to be excavated: /)L)/1E Z°y �6Ld
Number of cubic yards to be filled: 4 m o yr b c,�
Number of cubic yards to be graded: n
#6 Will this be a balanced cut and fill entirely within the site?
Yes No
If No: Will fill be brought on site? Yes_ A- No
Where does imported fill originate from? r
Does fill contain any potentially hazardous materials?
Yes No X
#7 Will excavated materials be taken off site?Yes No
If Yes: Where will excavated materials be taken?
L
#8 Briefly describe existing terrain, vegetation, and improvements on subject site? �4
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#9 Total size of area to be cleared 2-4 op SF acres/sq ft
Size of area to be cleared on slopes over 10% 2 4 o o 5 F AC/SF
#10 Has a soils report been completed on the subject site? 1) p
If yes, include copy with application.
#11 Is the subject site within 200 feet of a designated shoreline ()O
#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? 0
#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? 5%Ro�J �G�y ; ,-. ��� t 11 �C- E�� o
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#16 Will this land modification result in the redirection of any surface
water runoff onto adjacent properties? PO -
#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? �'J' R <ttcrt de,
#18 Will the land be replanted upon completion? VC
If yes, with what types of plants? rc-vC-
#19 Will this modification result in slopes steeper than those currently
on the site? If so, how steep?
Show following on the site plan.
Lot Dimensions Flood Zones
Existing Structures Fences n
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements Indicate Directional by (N, S, E, W)
Name of Flanking Street in relation to plot plan
Name of Fronting Street
APPLICANT TO DRAW SITE PLAN BELOW
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Show following on the site plan,;
,nsions '� Flood Zones
i Structures Fences
.ure Setbacks Driveways,
ar Lines Shorelines
-iinage Plan Topography
eptic Systems Wells
Proposed Improvements Easements indicate Directional by (N, S, E, W)
Name of Flanking Street in relation to plot plan
Name of Fronting Street
APPLICANT TO DRAW SITE PLAN BELOW
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