HomeMy WebLinkAboutGRD Application - 5/5/1993 I;; to U \11 1 r,
� MASON C ODNTY
LAND MODIFICATION PERMIT
MAY 0 5199' Depar=ent o' General Services
426 W. Cedar/P .O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
#1 Owner_
Si to Add+--ess Ci ty St
Owner Address_f� i �,y'_" Ci ty�R% Zip
`^ ✓�
Describe Work
#2 Contractor Name .&C'L A,U
Contractor
Address Expirati on da rw AQ)'*t0�
Ci ty St Zip Phone U81 #601 381 771 001 0001
#3 Engineer's Name 827 �eridcn Rd. 6'emerton, WA
98370
Phone# (206) 275-357r5 o i�n.c� 606
Address Ci ty St Zip
#4 Parcel NO.
Legal Description
#5 Number of cubic yards to be excavated:
Number of cubic ya_Tds to be filled:
Number of cubic yards to be graded:
#6 Will this be a balanced cut and fill entirely within the site?
Yes �_ No .
If NO: Will fill be brought on site? Yes No
Where does imported fill originate from?
Does fill contain any potentially hazardous mate_*-ials?
Yes No
#7 Will excavated materials be taken off site? Yes No _
If Yes: Where will excavated materials be taken?
#8 Briefly describe existing terr azn, vege to ti on, and imprcvemen is on
subject si te?
#9 Has a soils report been completed on the subject site?
If yes, include copy with application.
#10 Does the subject site contain any of the following features?
River Lake We t1 ands Sal twa te_T
Slope greater than 15-t Soft compressible soils
Seasonal Runoff None -
#11 Will the proposed land surface modification change the points
Where storm Water or -groundwater em tens or exits the site?
#12 Will the proposed land surface modification change the quality,
quancity, or velocity of storm wa ter/groundwa ter?
�1 -, ' s the subject site wittin 200 feet of a designated shoreline?
#i4 Wha-�it thods, if any, will be utilized to minimize erosion and
poss ble sedimentation into nearby craters?
#15 Will this land modification result in the redirection of any surface
crater- runoff onto adjacent properties?
#1 willre4r-face or subsurface runoff be collected or cont-rolled by
rote--ceptors, c-,=taro drains, or other water collection devices
once this land modification has been completed?
#17 will the land be replanted upon completion? /=5
If yes, with what types of plants?
#Z8 what are the lengths and hei
the site? ghts of slopes currently existing on
#19 will this modification result in slopes steeper than those currently
on the site? If so, how steep?
Show following on the site plan Directions to job site
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street
Name of Fronting S tree t
I
Scale:
Date: