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Home My WebLink AboutSHX2016-00044 JARPA Cancelled - SHX Permit / Conditions - 7/6/2016 P�Or1-STA MASON COUNTY E DEPARTMENT OF COMMUNITY DEVELOPMENT N �t o 7 o A N Planning Division >- o N z 615 W Alder St, Shelton, WA 98584 T N y ti (360)427-9670 OJ �O 1864 Exemption from Shoreline Management Act Case No.: SHX2016-00044 Substantial Development Permit Requirement The Proposal By: JERRY LADD P O BOX 800 ALLYN, WA 98524 Parcel Number: 122321400070 Site Address: 540 E CRONQUIST RD ALLYN To undertake the following development: SHORELINE EXEMPTION SUBMITTED FOR LADD EXISTING MOORING BUOY Within CASE INLET and/or its associated wetlands is exempt from the requirement of substantial development because the development is categorized under WAC 173-27-040(2) as being category A-does not exceed dollar threshold Please contact Kell McAboy at ext 365 if you have any questions. Issued:7/6/2016 Authorized Local Government Official COUNTY COMMMUNITYSERVICES RECEIVED Building 8—615 W.Alder Street JUN 13 2016 Shelton,WA 98584 (360)427-9670—Ext.357 615 W. Alder Street SHORELINE PERMIT APPLICATION PERMIT NO. 6NX M I 0- 00044 SHORELINE SUBSTANTIAL DEVELOPMENT SHORELINE VARIANCE* DATE RECEIVED . 19104V SHORELINE CONDITIONAL USE- SHORELINE EXEMPTION �— The Washington State Shoreline Management Act (RCW 90.58) requires that substantial developments within designated shorelines of the state comply with its administrative procedures(WAC 173-14)and the provisions of the Mason County Shoreline Management Master Program.The purpose of this Act and local program is to protect the state's shoreline resources. The program requires that substantial development(any development of which the total cost or fair market value exceeds $5,718.00 or materially interferes with the normal public use of the water or shorelines of the State be reviewed with the goals, polices, and performance standards established in the Master Program. Answer all questions completely. Attach any additional information that my further describe the�jToposed development. Incomplete applications will be returned. n (p h&rKar`�O 7e.J2_@.," Sho'relMk Variances and Conditional aces haVe additibul pages th9t Shall be attached to this application. APPLICANT: Jerry Ladd ADDRESS: Po Box 800 Allyn (street) WA. 98524 (city) (state) (zip) TELEPHONE: 303 710 1970 (home) (business) AUTHORIZED REPRESENTATIVE: LaVeta Arnold ADDRESS: 280 Griel Rd. (StrCe6nalaska WA. 98570 TELEPHONE: (City) 360 978 5157 (ate) (zip) PROPERTY DESCRIPTION: General location(include property address,water body and associated wetlands—identify the name of the shoreline): 540 E Cronquist Rd. Allyn WA. 98524 Case Inlet Legal description (include section, township, and range to the nearest quarter, quarter section or latitude and longitude to the nearest minute. Projects located in open water areas away from land shall provide a longitude location)—include all parcel numbers: 122 32 1 L4 CCU OWNERSHIP: X Contract Applicant Owner Lessee Purchaser (Identify) Other Owner: Jerry Ladd 540 Cronquist Allyn (street) WA 98524 (city) (state) (zip) DEVELOPMENT DESCRIPTON Development(identify and describe the proposed project,including the type of materials to be used,construction methods,principle dimensions,and other pertinent information): (2) SS175 Helix embedment anchors (8' apart), each connected to a 6' x 1'/4" double braided nylon rope with thimbles at each end attached to 7/8" shackles to 7/8" swivel to 45' 1 W double braided nylon pennant line with thimbles at each end with two midline floats attached to 7/8" shackle attached to 7/8" swivel attached to 7/8" shackle connected to 6' 5/ galvanized ong length chain, which passes through a 24" hardshell buoy with retrieval near ring Use(identify current use of property with exist improvements: Single family waterfront home in good condition Reason for requesting development: Shoreline exemption WAC 197-11-800(24)(f) for existing mooring buoy for residential waterfront property. Installed March 14, 2010 for a 58' vessel ACKOWLEDGEMENT I hereby declare,to the best of my knowledge and belief,the forgoing information and all attached information is true and correct. 6 7 l"�� Lf OA= fc--� (Applican or authorized representative (Date) -------------------------------------- AGENCY USE ONLY Date received: U WASHINGTON STATE S Army Corps of Engineers i i Joint Aquatic Resources Permit Agency reference#: Application (JARPA) Form',' [he Tax Parcel#(s): USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. ------------------------------- i Part 1—Project Identification 1. Project Name (A name for your project that you create. Examples:Smith's Dock or Seabrook Lane Development) [belpj Ladd Existing Mooring Part 2—Applicant The person and/or organization responsible for the project. [help] 2a. Name (Last, First, Middle) Ladd, Jerry 2b. Organization (If applicable) 2c. Mailing Address (street or PO Box) PO Box 800 2d. City, State, Zip Allyn, WA 98524 2e. Phone(1) 2f. Phone(2) 2g. Fax 2h. E-mail (303) 710-1970 ( ) ( ) Jdl@doorwaysinc.com Additional forms may be required for the following permits: • If your project may qualify for Department of the Army authorization through a Regional General Permit(RGP),contact the U.S.Army Corps of Engineers for application information(206)764-3495. • If your project might affect species listed under the Endangered Species Act,you will need to fill out a Speck Project Information Form(SPIF)or prepare a Biological Evaluation. Forms can be found at ham://www.nws.usace.arTny.mil/Missions/C ivilW orks/Regulatory/PermkGuidebook/EndangeredSpecies.aspx. • Not all cities and counties accept the JARPA for their local Shoreline permits. If you need a Shoreline permit,contact the appropriate city or county government to make sure they accept the JARPA. 2To access an online JARPA form with[help]screens,go to htt�://www.epermitting.wa.gov/site/alias resourcecenterharpa iarpa form/9984flarpa form.aspx. For other help,contact the Governor's Office for Regulatory Innovation and Assistance at(800)917-0043 or helpaloria.wa.gov. JARPA Revision 2015.1 Page 1 of 12 Part 3—Authorized Agent or Contact Person authorized to represent the applicant about the project. (Note: Authorized agent(s) must sign 11 b of this application.) [ 3a. Name (Last, First, Middle) Arnold, LaVeta 3b. Organization (If applicable) 3c. Mailing Address (street or Po Box) 280 Grief Rd. 3d. City, State, Zip Onalaska, WA 98570 3e. Phone(1) 3f. Phone(2) 3g. Fax 3h. E-mail (360) 978-5157 ( ) ( ) alphamarineoffice@gmail.com Part 4—Property Owner(s) Contact information for people or organizations owning the property(ies) where the project will occur. Consider both upland and aquatic ownership because the upland owners may not own the adjacent aquatic land. [ Same as applicant. (Skip to Part 5.) ❑ Repair or maintenance activities on existing rights-of-way or easements. (Skip to Part 5.) ❑ There are multiple upland property owners. Complete the section below and fill out JARPA Attachment A for each additional property owner. El Your project is on Department of Natural Resources (DNR)-managed aquatic lands. If you don't know, contact the DNR at (360) 902-1100 to determine aquatic land ownership. If yes, complete to apply for the Aquatic Use Authorization. 4a. Name (Last, First, Middle) 4b. Organization (If applicable) 4c. Mailing Address (street or Po Box) 4d. City, State, Zip 4e. Phone(1) 4f. Phone(2) 4g. Fax 4h. E-mail JARPA Revision 2015.1 Page 2 of 12 Part 5—Project Location(s) Identifying information about the property or properties where the project will occur. LheM ❑ There are multiple project locations (e.g. linear projects). Complete the section below and use JARPA Attachment B for each additional project location. 5a. Indicate the type of ownership of the property. (Check all that apply.) hel Private ❑ Federal ❑ Publicly owned (state,county, city, special districts like schools, ports, etc.) ❑ Tribal ❑ Department of Natural Resources (DNR)— managed aquatic lands (Complete JARPA Attachment E) 5b. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5p.) [helA 540 E. Cronquist Rd. 5c. City, State, Zip (if the project is not in a city or town, provide the name of the nearest city or town.) hf eM Allyn, WA 98524 5d. County hel Mason 5e. Provide the section, township, and range for the project location. heI '/. Section Section Township Range NE 32 22N 01 W 5f. Provide the latitude and longitude of the project location. pLeipj • Example:47.03922 N lat./-122.89142 W long. (Use decimal degrees -NAD 83) N 47.353380 N lat / -122.8238° W long 5g. List the tax parcel number(s)for the project location. hel • The local county assessors office can provide this information. 12232-14-00070 5h. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment C.) [help] Name Mailing Address Tax Parcel # (if known) Valluzzo, Robert& Janis 8900 NE 16th St. 12232-10-02061 Clyde Hill, WA 98004 Nelson, Vernon & Susan PO Box 160 12232-10-02070 Grapeview, WA 98546 JARPA Revision 2015.1 Page 3 of 12 5i. List all wetlands on or adjacent to the project location. hem N/A 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. [help] Case Inlet 5k. Is any part of the project area within a 100-year floodplain? [Leipj Yes ❑ No ❑ Don't know 5301150150C 51. Briefly describe the vegetation and habitat conditions on the property. hei Type of substrate at anchor location: Sand, mud mix over tight glacial till Vegetation: No Vegetation 5m. Describe how the property is currently used. !ei Private, residential waterfront home. 5n. Describe how the adjacent properties are currently used. hei Residential 5o. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition. hey Single family residential home 5p. Provide driving directions from the closest highway to the project location, and attach a map. h� eiPl yt, Q 17734 E WA-3, Allyn, WA 98524 O 17734 E WA-3, Allyn,WA 98S24 ,�, Depart E Grapeview loop Rd toward E Gills Cove Dr 2 1 nu c Bear left onto E Cronquist Rd 06Ml Arrive at E Cronquist Rd Soo E Cronquist Tre ast rtersect.or is E Graperew Loop Rd Rd.Allyn,WA 98524 0 540 E Cronquist Rd,Allyn,WA 98524 E Cronquist WA 98'S24 JARPA Revision 2015.1 Page 4 of 12 Part 6—Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. hel An existing, permanent helical embedment anchor with suspended pennant line, used as a recreational mooring buoy in front of private residential owned waterfront property. I 6b. Describe the purpose of the project and why you want or need to perform it. [ DEPTH OF WATER AT MEAN LOWER LOW TIDE: 29 ft. 157 yds off HWM For secure boat mooring in front of waterfront residence Boat Length: 58 Feet 6c. Indicate the project category. (Check all that apply) [help] ❑ Commercial Residential ❑ Institutional ❑ Transportation Recreational ❑ Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements of your project. (Check all that apply) [help] ❑ Aquaculture ❑ Culvert ❑ Float ❑ Retaining Wall ❑ Bank Stabilization ❑ Dam /Weir (upland) ❑ Floating Home ❑ Boat House ❑ Dike / Levee / Jetty ❑ Geotechnical Survey ❑ Road ❑ Boat Launch ❑ Ditch ❑ Land Clearing ❑ Scientific Measurement Device ❑ Boat Lift ❑ Dock / Pier ❑ Marina / Moorage ❑ Stairs ❑ Bridge ❑ Dredging ❑ Mining ❑ Stormwater facility ❑ Bulkhead ❑ Fence ❑ Outfall Structure ❑ Swimming Pool Buoy ❑ Ferry Terminal ❑ Piling/Dolphin ❑ Utility Line ❑ Channel Modification ❑ Fishway ❑ Raft ❑ Other: JARPA Revision 2015.1 Page 5 of 12 6e. Describe how you plan to construct each project element checked in 6d. Include specific construction methods and equipment to be used. hel • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year floodplain. A permanent embedment helical anchor and mooring buoy ball centered off property. (2) SS175 Helix embedment anchors (8' apart), each connected to a 6' x 1'/4"double braided nylon rope with thimbles at each end attached to 1 1/8" shackles to 7/8" swivel to 45' 1 '/4" double braided nylon pennant line with thimbles at each end with two midline floats attached to 7/8"shackle attached to 7/8" swivel attached to 7/8" shackle connected to 6' 5/8" galvanized long length chain, which passes through a 24"hardshell buoy with 3/4" retrieval pear ring on top. Maintained and cleaned by Alpha Marine Installation 6f. What are the anticipated start and end dates for project construction? (Month/Year) hem • If the project will be constructed in phases or stages, use JARPA Attachment D to list the start and end dates of each phase or stage. Start date: End date: 3/14/2010 ❑ See JARPA Attachment D 6g. Fair market value of the project, including materials, labor, machine rentals, etc. n[ elp) $2200. 6h. Will any portion of the project receive federal funding? hel • If yes, list each agency providing funds. ❑ Yes 0 No ❑ Don't know Part 7—Wetlands: Impacts and Mitigation ❑ Check here if there are wetlands or wetland buffers on or adjacent to the project area. (If there are none, skip to Part 8.)[hel 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. hem Not applicable 7b. Will the project impact wetlands? [hel ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers? heI ❑ Yes ❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? hel • If Yes, submit the report, including data sheets,with the JARPA package. ❑ Yes ❑ No 7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating System? [hel • If Yes, submit the wetland rating forms and figures with the JARPA package. JARPA Revision 2015.1 Page 6 of 12 ❑ Yes ❑ No ❑ Don't know 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? h[ ell • If Yes, submit the plan with the JARPA package and answer 7g. • If No, or Not applicable, explain below why a mitigation plan should not be required. ❑ Yes ❑ No ❑ Not applicable 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. hem 71h. Use the table below to list the type and rating of each wetland impacted, the extent and duration of the impact, and the type and amount of mitigation proposed. Or if you are submitting a mitigation plan with a similar table, you can state (below) where we can find this information in the plan. hf eld Activity (fill, Wetland Wetland Impact Duration Proposed Wetland drain, excavate, Name' type and area (sq. of impact3 mitigation mitigation area flood, etc.) rating ft. or type (sq. ft. or category2 Acres) acres) If no official name for the wetland exists,create a unique name(such as"Wetland 1"). The name should be consistent with other project documents,such as a wetland delineation report. 2 Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System.Provide the wetland rating forms with the JARPA package. 3Indicate the days,months or years the wetland will be measurably impacted by the activity.Enter"permanent"if applicable. `Creation(C),Re-establishment/Rehabilitation(R), Enhancement(E),Preservation(P),Mitigation Bank/In-lieu fee(B) Page number(s)for similar information in the mitigation plan, if available: 7i. For all filling activities identified in 7h, describe the source and nature of the fill material, the amount in cubic yards that will be used, and how and where it will be placed into the wetland. h[ elal 7j. For all excavating activities identified in 7h, describe the excavation method, type and amount of material in cubic yards you will remove, and where the material will be disposed. LLeld Part 8—Waterbodies (other than wetlands): Impacts and Mitigation In Part 8, "waterbodies" refers to non-wetland waterbodies. (See Part 7 for information related to wetlands.) nel ❑ Check here if there are waterbodies on or adjacent to the project area. (If there are none, skip to Part 9.) 8a. Describe how the project is designed to avoid and minimize adverse impacts to the aquatic environment. hem ❑ Not applicable Helical anchor has minimal foot print and suspended line avoids drag circles to sea bed. JARPA Revision 2015.1 Page 7 of 12 8b. Will your project impact a waterbody or the area around a waterbody? [heipl Yes ❑ No 24" Buoy 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? hel • If Yes, submit the plan with the JARPA package and answer 8d. • If No, or Not applicable,explain below why a mitigation plan should not be required. ❑ Yes ❑ No 0 Not applicable Has no impact on surrounding environment 8d. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan. • If you already completed 7g you do not need to restate your answer here. [hel N/A 8e. Summarize impact(s)to each waterbody in the table below. neI Activity (clear, Waterbody Impact Duration Amount of material Area (sq.ft. or dredge, fill, pile name' location of impact3 (cubic yards)to be linear ft.) of drive, etc.) placed in or waterbody removed from directly affected waterbody Helical /Puget Sound LAT: N Permanent None N/A Embedment Embedment 47.353380 Anchor Anchor LONG: W -122.82380 'If no official name for the waterbody exists,create a unique name(such as"Stream 1")The name should be consistent with other documents provided. 2Indicate whether the impact will occur in or adjacent to the waterbody. If adjacent,provide the distance between the impact and the waterbody and indicate whether the impact will occur within the 100-year flood plain. 3Indicate the days,months or years the waterbody will be measurably impacted by the work. Enter"permanent"if applicable. 8f. For all activities identified in 8e, describe the source and nature of the fill material, amount (in cubic yards) you will use, and how and where it will be placed into the waterbody. h[ eip N/A 8g. For all excavating or dredging activities identified in 8e, describe the method for excavating or dredging, type and amount of material you will remove, and where the material will be disposed. hl elal None. No soil or vegetation was removed. No dredging. Helical anchor screws in substrate without disturbing environment, soil lays back around anchor site leaving 1 3/4 inch foot print. JARPA Revision 2015.1 Page 8 of 12 Part 9—Additional Information Any additional information you can provide helps the reviewer(s) understand your project. Complete as much of this section as you can. It is ok if you cannot answer a question. 9a. If you have already worked with any government agencies on this project, list them below. Lbgid Agency Name Contact Name Phone Most Recent Date of Contact 9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 of this JARPA on the Washington Department of Ecology's 303(d) List? Lhel • If Yes, list the parameter(s)below. • If you don't know,use Washington Department of Ecology's Water Quality Assessment tools at: http://www.ecy.wa.gov/programs/wq/303d/. ❑ Yes ❑ No NIA 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? h[ eM • Go to http://cfpub.epa.gov/surf/locatelindex.cfm to help identify the HUC. 17110019 9d. What Water Resource Inventory Area Number(WRIA#) is the project in? heI • Go to http://www.ecy.wa.gov/services/gis/maps/wria/wria.htm to find the WRIA#. WRIA# 14 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? hel • Go to http://www.ecv.wa.aov/programs/wa/swgstcrkeria.html for the standards. ❑ Yes ❑ No Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? LbLeM `` ,i� • If you don't know,contact the local planning department. V`r hav,,. • For more information,go to: http://www.ecv.wa.gov/programs/sea/smaAaws rules/173-26/211 designations.html. Rural 00 Urban ❑ Natural Aquatic ❑ Conservancy ❑ Other 9g. What is the Washington Department of Natural Resources Water Type? [ ell • Go to http://www.dnr.wa.govtforest-practices-water-typing for the Forest Practices Water Typing System. Shoreline ❑ Fish ❑ Non-Fish Perennial ❑ Non-Fish Seasonal 91h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? hti • If No, provide the name of the manual your project is designed to meet. JARPA Revision 2015.1 Page 9 of 12 ❑ Yes ❑ No N/A Name of manual: 9i. Does the project site have known contaminated sediment? LLeipj • If Yes, please describe below. ❑ Yes M No 9j. If you know what the property was used for in the past, describe below. hel Waterfront home 9k. Has a cultural resource (archaeological)survey been performed on the project area? t,� PM • If Yes, attach it to your JARPA package. ❑ Yes M No 91. Name each species listed under the federal Endangered Species Act that occurs in the vicinity of the project area or might be affected by the proposed work. LheM N/A No effect 9m. Name each species or habitat on the Washington Department of Fish and Wildlife's Priority Habitats and Species List that might be affected by the proposed work. hf !-M N/A No effect Part 10—SEPA Compliance and Permits Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at http://apps.oria.wa.gov/opas/. • Governor's Office for Regulatory Innovation and Assistance at(800) 917-0043 or help(&-oda.wa.gov. • For a list of addresses to send your JARPA to, click on agency addresses for completed JARPA. 10a. Compliance with the State Environmental Policy Act(SEPA). (check all that apply.) [be I • For more information about SEPA,go to www.ecy.wa.gov/programs/seatsepa/e-review.html. ❑ A copy of the SEPA determination or letter of exemption is included with this application. ❑ A SEPA determination is pending with (lead agency). The expected decision date is ❑ I am applying for a Fish Habitat Enhancement Exemption. (check the box below in 10b.)[held This project is exempt (choose type of exemption below). Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? WAC 197-11-800(24)(fl ❑ Other: ❑ SEPA is pre-empted by federal law. JARPA Revision 2015.1 Page 10 of 12 10b. Indicate the permits you are applying for. (Check all that apply.) [helpl LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance Shoreline Exemption Type (explain): �kWt wC\ ��LoVAS Other City/County permits: ❑ Floodplain Development Permit ❑ Critical Areas Ordinance STATE GOVERNMENT Washington Department of Fish and Wildlife: ❑ Hydraulic Project Approval (HPA) ❑ Fish Habitat Enhancement Exemption—Attach Exemption For, You must submit a check for$150 to Washington Department of Fish and Wildlife, unless your project qualifies for an exemption or alternative payment method below. Do not send cash. Check the appropriate boxes: ❑$150 check enclosed. Check# Attach check made payable to Washington Department of Fish and Wildlife. ❑My project is exempt from the application fee. (Check appropriate exemption ❑ HPA processing is conducted by applicant-funded WDFW staff. Agreement# ❑ Mineral prospecting and mining. ❑ Project occurs on farm and agricultural land. (Attach a copy of current land use classification recorded with the county auditor, or other proof of current land use.) ❑ Project is a modification of an existing HPA originally applied for, prior to July 10, 2012. HPA# Washington Department of Natural Resources: ❑ Aquatic Use Authorization Complete JARPA Attachment E and submit a check for$25 payable to the Washington Department of Natural Resources. Do not send cash. Washington Department of Ecology: ❑ Section 401 Water Quality Certification FEDERAL GOVERNMENT United States Department of the Army permits (U.S. Army Corps of Engineers): ❑ Section 404 (discharges into waters of the U.S.) Section 10 (work in navigable waters) United States Coast Guard permits: ❑ Private Aids to Navigation (for non-bridge projects) JARPA Revision 2015.1 Page 11 of 12 Part 11—Authorizing Signatures Signatures are required before submitting the DARPA package. The DARPA package includes the JARPA form, project plans, photos, etc. [help] 11 a.Applicant Signature (required) ht el I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities, and I agree to start work or after I have received all necessary permits. I hereby authorize agent named in Part 3 of this application to act on my behalf in matters related to this application. (initial) By initialing here, I state that I have the authont to grant access to,�he property. I also give my consent to the permitting agencies entering t roped here th project i located to inspect the project site or any work related to the project. �. ( i ►) Applicant Pri red Nome Appli nt gnature baie 11 b.Authorized Agent Signature hel I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities and I agree to start work only after all necessary pe its have been issued. --C' ,6k -� Z't--U:�'-:_-�71-� - Authorized Agent Printed Name Authorized Agent Signaturb Date 11 e. Property Owner Signature (if not applicant) [heipl Not required if project is on existing rights-of-way or easements. I consent to the permitting agencies entering the property where the project is located to inspect the project site or any work. These inspections shall occur at reasonable times and, if practical, with prior notice to the landowner. Property Owner Printed Name Property Owner Signature Date 18 U.S.0§1001 provides that:Whoever, in any manner within the jurisdiction of any department or agency of the United States knowingly falsifies,conceals, or covers up by any trick,scheme,or device a material fact or makes any false,fictitious, or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false,fictitious, or fraudulent statement or entry,shall be fined not more than$10,000 or imprisoned not more than 5 years or both. If you require this document in an format,contact the Govemor's office for Regulatory Innovation and Assistance (ORIA)at(800)917-0043. People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call 03M 833-6341. ORIA publicaUpn ni.n bef FNV-019-09 rev. 09/2015 ___ Cross Section Jerry Ladd Existing Mooring Alpha Marine Installations 47.363 N lat -122.8238'W long Series I Mooring System Case Inlet TOP MINIG VESSEL 24"MOOFING BUOrf 157 yds off HWM 61 518"QALVNdZED MLW: 29' LONG LINK CHAIN 7/8" QALVANOW SWIVEL AND SHACKLE (2) ILP MIDUNE FLOAT 45' 25" from I,DOUBLE BRAIDED anchor NYLON ROPE <:n 7' from GALVANIZED THIMBLE AT anchor 718" (3ALVANMM Vegetation: None EACH END OF NYLON ROPEk 1 .. SWIVEL AND SHACKLE (2) 11 Galvanized Shackles Substrate: Sand and mud mix BEA FLOOR r (2) SS175 8"/10" Double Helix Anchors 72111111 400now b dw P000MY md comfidaidd Designed by: pwpmy of A*k 160dw boo1ldh=4 LLC,7bb d000mmi=my Lot be capK Alpha Marine Installations, LLC nP0684 of dwdo@4 an whole or In ft Ofaft w COMM OfA4ft MWIN hUM91adonk=a1sftb*=vd=1y9xdwpmyn e*wwW&fthwbmxuppAW& 280 Griel, Road ---a 7 WA 98570 CMd&0 2OW,2001,20A A4&Ma i hb Onalaska, m isudocuk UC. AM d*ft.ww, Phone (360) 978-5157 f Site Ma Parcel Number: 12232-14-0070 p �'`� Quarter Section: NE Ladd Section: 32 Township: 22N Existing Mooring Range: 01W Position: 47 35338 N lat 122 8238 W long ` Address: 540 E Cronqust Rd Allyn WA 98524 Mason County Case Inlet c 550 c, Jerry Maf!lo4 I add W 00070 VeFnon& Susan Nelson w `-; Rd 157 yd O HWM PALW: 29' > J� N 1 Ladd Vicinity Map Existing Mooring • %lap Bats f2C16vc T.rns of Use Repo,- i I - - I u � �. t: ."a�i�(?'.+' s6kt�iE''" !`.<: _. ... .� .ir '�-Y, ?: � {r #ir 77►►..xa � ..> is ..'�i: - �. a �,..,.. ..c '�.�•. E a ;r