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Home My WebLink AboutGRD2021-00015 - GRD Application - 11/23/2021 I MASON COVLANN ING PERMIT N0. 2021 060 DEPARTMENT OF COMMUNITY DEVELOPMENT 'RECEIVED ` BUILDING•PLANNING FIRE MARSHAL WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352 Mason County Bldg.8, (360)275-4467 Belfair ext.352 NOV 2 3 2021 615 W.Alder Street,Shelton,WA 98584 (360)482-5269 Elma ext.352 LAND MODIFICATION PERMIT (Grading Permit) 615 W. Alder Street OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: f f0v5 15 NAME: 5a M-c- z y`/ w BOClt I� iJ`l( MAII ING ADDRESS: MAILING ADDRESS: !V CITY: STATE: WA ZIP:5,1`3g 3 CITY: STATE: ZIP: PHONE: 366 -535--1otXCELL: 360504 If PHONE: CELL: E : &fA1L� KDvs1Hg `k6 ��G� EMAIL 1 �IRNUTION: ��_ n L&I REG# EXP.PARCEL ?W t Onn Off' 5 r i S PARCEL NUMBER(12 DIGIT NUMBER) c't a f4 G �t FIRE DISTRICT LEGAL DESCRIPTION(ABBREVIATED): CITY AT SITE ADDRESS LV e_ I A w DIRECTIONS SITE ADDRESS 0a 3 � r.1 6b IS PROPERTY WITHIN 200 FT: SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES El NO Pf- WILL TIMBER BE CUT AND SOLD IN PARCEL PREPARATION? YES❑ NO IM TYPE OF JOB: EXCAVATION ❑ FILLING ❑ GRADING 9 CUTTING ❑ OTHER ❑ TOTAL SIZE OF PARCEL 9F y 7 ACRES/SQ FT SIZE OF AREA TO BE EFFECTED ACRES/SQ FT ESTIMATED AMOUNTY OF tUBIC YARDS 2 'N Z DOES THE SITE HAVE SLOPES 14%OR GREATER YES[] N0 DESCRIBE SCOPE OF WORK WILL FILL BE BROL;IGHT ON SITE? IF YES,SITE ADDRESS: D WILL EXCAVATED MATERIAL BE TAKEN OFF SITE?IF YES,SITE ADDRESS: YES ❑ NOj� DOES FILL CONTAIl41 POTENTIAL HAZARDOUS MATERIALS?HAS A SOILS REPORT BEEN COMPLETEDYES ON SITE?IF YES,INCLUDE A COPY. ❑ NO WILL PROPSAL RESULT IN REDIRECTION OF ANY SURFACE WWATER RUNOFF? YES ❑ NO 54 WILL WORK ALTER WHERE STORMWATER OF GROUND WATER ENTERS OR EXISTS THE SITE? YES❑ NOR WILL QUALITY,QUANTITY OR VELOCITY OF STORM/GROUND WATER BE ALTERED? YES❑ N0� WILL THE RUNOFF BE COLLETED/CONTROLLED BY INTERCEPTORS,CURTAIN DRAINS OR OTHER DEVICES? YES❑ NO WILL THE LAND BE REPLANTED UPON COMPLETION? YES❑ NO WILL THE PROPOSAL RESULT IN SLOPES STEEPER THAN THOSE CURRENTLY ON SITE? YES❑ NO IS THE SITE WITHIN 200 FT OF A DESIGNATED SHORELINE OR A WETLAND? YES❑ NOR OWNER I BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or contractor. I further declare that I am entitljed to receive this permit and to do the work as proposed.I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review on;This perm it/application becomes null&void if work or authorized construction is not commenced within 180 d or if cons ction work is suspended for a pe' of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTIO NACTIVI OF TH PERM LICATION OF 180 DAYS WILL IN9VAL2DAT THE APPLICATION. X nature of Appli nt � / Date X �Gvt I fV OWNER EPRESENTATIVE/ ONTRACTOR Print Name ! (CIRCLE TO IN TE) r � Parcel Number:122205067005 Parcel Number:122205066006 Legal Description: Legal Description: ALLYN PTN LOTS 5-7 BLK:67 TGW VAC ALLYN PTN LOTS 7-9 BLK:67&LOTS 7-9 BLK:66 TGW ST PCL 1 OF BLA#19-36 AF#2122881 VAC Size in Acres:0.22 ALLEY&ST PCL 4 OF BLA#19-36 AF#2122881 Size in Acres:0.24 Parcel Number:122205067008 Legal Description: ALLYN PTN LOTS 7-9 TGW VAC ST PCL Parcel Number:122205066007 6 OF BLA#19-36 AF#2122881 Legal Description: Size in Acres:0.22 ALLYN PTN LOTS 9-10 BLK:66 TGW VAC ALLEY&ST PCL 9 OF BLA#19-36 AF#2122881 Size in Acres:0.32 Parcel Number:122205067009 Legal Description: ALLYN PTN LOTS 9-10 BLK:67 TGW Parcel Number:122205064001 VAC STS PCL 7 OF BLA#19-36 AF#2122881 Legal Description: Size in Acres:0.22 ALLYN PTN LOTS:1-2 BLK:64&VAC PTN STREETS&ALLEY ADJ PCL 10 OF BLA#19-36 AF #2122881 Parcel Number:122205063002 Size in Acres:0.30 Legal Description: ALLYN PTN LOTS 1-2 BLK:63 TGW VAC STS PCL 12 OF BLA#19-36 AF#2122881 Size in Acres:0.22 Parcel Number:122205067006 Legal Description: ALLYN PTN LOTS 5-7 BLK:67 TGW VAC ALLEY PCL 2 OF BLA#19-36 AF#2122881 Size in Acres:0.13 Parcel Number:12220SO67007 Legal Description: ALLYN PTN LOTS 7-9 BLK:67&LOTS 7-9 BLK:66 TGW VAC ALLEY PCL 5 OF BLA#19-36 AF#2122881 Size in Acres:0.15 Parcel Number: 122205067010 Legal Description: ALLYN PTN LOTS 9-10 BLK:67&LOTS 9-10 BLK:66 TGW VAC ALLEY&ST PCL 8 OF BLA#19-36 AF #2122881 Size in Acres:0.16 Parcel Number:122205063001 Legal Description: ALLYN PTN LOTS 1-2 BLK:64&LOTS 1-2 BLK:63 TGW VAC ALLEY&STS PCL it OF BLA#19-36 AF#2122881 Size in Acres:0.17 Parcel Number:122205066005 Legal Description: ALLYN PTN LOTS 5-7 BLK:67&LOTS 5-7 BLK:66 TGW VAC ALLEY PCL 3 OF BLA#19-36 AF#2122881 Size in Acres:0.20