HomeMy WebLinkAboutMEP2013-00006 Cancelled - MEP Permit / Conditions - 2/22/2013 f •
MASON ENVIRONMENTAL PERMIT($630 0$3380 /other permit) Mason County Permit Center Use:
❑ CONDITIONAL USE($1520) MEP 2-6 1 - 6WO
HABITAT MANAGEMENT PLAN REVIE ($445)
Date Rcvd 1261
MASON COUNTY 02-22-13A09 : 37 RCVD
DEPARTMENT OF COMMUNITY DEVELOPMENT
Mason County Resource Ordinance(Chapter 17.01 MCC)
ENVIRONMENTAL PERMIT APPLICATION
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: T - "t vkv I S t}
Mailing Address:
Work Phone: Email Address:
Home/Cell Phone: Fax#:
If an agent is acting for the property owner during the permit process, complete#2.
2. AUTHORIZED AGENT
Name: LA�gR 7��Ck_
Mailing Address:
oa C�zEa l ki A A.l iJr't'
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Work Phone: > D....Z 3 Email Address
Home/Cell Phone: Fax
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3.PROJECT SITE �?
Site Address: L4 �U �j� nj , �G& /— ( Z.Z.�j
Parcel#: CA�2 ! -76 _ Lega] Description
Directions to Site:
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Attach a site plan Slowing 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.
I
4. State which section requires permit:
❑ Long Term Commercial Forest,Chapter 17.10.060 ❑ Frequently Flooded Areas,Chapter 17.01.090
❑ Mineral Resource Lands,Chapter 17.01.066 ❑ Landslide Hazard Area,Chapter 17.01.100
❑ Aquifer Recharge Area,Chapter 17.01.080 ❑ Seismic Hazard Areas,Chapter 17.01.102
❑ Erosion Hazard Area,Chapter 17.01.104 ❑ Fish&Wildlife Habitat.Conservation Areas,Chapter
❑ In-Holding Lands,Chapter 17.01.062 17.01.110
® Wetlands,Chapter 17.01.070
5. Identify current use of the property with existing improvements:
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): i
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IACLA� r-es,�D j"\�,
7. Describe why the action requiring this permit cannot be avoided.
P QZ:PV S�fl Ln(,A'r\Orl -N' C atyJ W C L.L 11 w era\a Ceo FEET a F t r1E
WEtLA�S� P��f'Tcvannlbt of 3o -L EES Tt1E
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8. Will there be an alteration of a wetland and/or wetland vegetation area(circle one)? Yes 0°
9. Identifi'an surface water on or adjacent to property(circle one):
Y
Saltwater Lake Stream Pond Wetland Drainage Ditch
10. Identify existing septic/sewer connection(circle one): If septic is located on project site,include records.
Connected to Septic Connected to Community Septic 0 oW E
11. Identify existing water supply(circle one): Public Water Supply Well W o►.1 E
11. Type of Job(circle one):
New Ad Alteration Repair molition Other:
Print Name atu a Date
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