HomeMy WebLinkAboutMEP2021-00010 - MEP Permit / Conditions - 6/15/2021 PLANNING
MASON COUNTY Mason County Pernvt Center Use:
COMMUNITY SERVICES MEP?1021 - 00010
Building,Planning,Environmental Health,Community Health Date Rcvd
615 W.Alder St.—Bldg.8,Shelton,W a 98584
Phone:(360)427-9670 ext.352♦Fax:(360)427-7798
MASON ENVIRONMENTAL PERMIT:$115 R C�
❑ MASON ENVIRONMENTAL PERMIT WITH HABITAT MANAGEMENT PLAN:$1500
❑ CONDITIONAL USE: $2000 6
?�21
Mason County Resource Ordinance(Chapter 8.52 MCC) 1 5 JUN 15
ENVIRONMENTAL PERMIT APPLICATION VV A/der Street
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:
Mailing Address: G 13 M. 4, 90
Work Phone: zs Z_111r Email Address: 0,,,eeAP
Hom Cell hone ,O7,4Fax#: JIA
I an agent is actingfor the property owner during the permit process,complete 42.
2.AUTHORIZED AGENT
Name: lmt-z -Se
Mailing.Address: .5, gocr
Work Phone: Email Address:
Home/Cell Phone: Fax#
3.PROJECT SITE
Site Address:
Parcel#: f 223Z - L3 Legal Description:
Directions to Site: 1� 3 0 �'P IQA"/ V�- r o
at �"�. Ae;, 49,,j E c;,5�-P p Pl
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
f 1
4 State which section requires permit:
. S q
❑ 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:
To guf/—b ,s �"2
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):
/%,rk--New./ .s.F,�. �Gs/,J S'�rl,�a,4,2 b i�cio�:z 'iG ,e• �d�L
7. Describe why the action requiring this permit cannot be avoided.
/S - C�,c1L.� ACP—X �trizS�64,9 Ei4 �DaJST�i�G' /ryn).
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 etlan� Drainage Ditch
10. Identify existing septic/sewer connection(circle one): If septic is located on project si indndue.cords.
Connected to Septic Connected to Community Septi NN ep fi G '� bt t�Sfic
11. Identify existing water supply(circle one): Public Water Supply ell
11. Type of Job(circle one):
Ne Add Alteration Repair oiition Other:
Print Name Signature Date
Rev.March 1,2018