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HomeMy WebLinkAboutGRD2023-00003 - GRD Application - 2/17/2023 RECEIVED MASON COUNTY MAR 03 2023 PERMIT NO OZ�I DEPARTMENT OF COMMUNITY DEVELOPMENT (M wo; BUILDING• PLANNING-FIRE. WWW.CO.MASON.WAUS Ald( o) 5Ps�ito Shelton ext.352 Mason County Bldg.8, (360)275-4467 Belfair ext.352 ISM 615 W.Alder Street,Shelton,WA 98584 (360)482-5269 Elma ext. 352 LAND MODIFICATION PERMIT (Grading Permit) OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: Overton &Associates Attn: David Overton NAME: TBD MAILING ADDRESS: PO Box 1477 MAILING ADDRESS: CITY: Tacoma STATE: WA ZIP: 98401 CITY: STATE: ZIP: PHONE: 206-948-0554 CELL: PHONE: CELL: EMAIL: david@eeoverton.com EMAIL: L&I REG# EXP. PARCEL INFORMATION: North mason v Regional Fire I�� PARCEL NUMBER(12 DIGIT NUMBER) 12321-43-00130, 12321-44-00000,12321-41-00010 FIRE DISTRICT Authority LEGAL DESCRIPTION(ABBREVIATED):E1/2 of NWi/4 of Sec.28&SE114 of SW1/4 and SE1/4 of Sec 21 Twp 23N Rge 1W SITE ADDRESS 25252 NE State Route 3 CITY Belfair DIRECTIONS TO SITE ADDRESS WA-3 North for approximately 27 miles,site is on right side IS PROPERTY WITHIN 200 FT: SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND ❑x SEASONAL RUNOFF❑ STREAM ❑ DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES❑ NO❑ WILL TIMBER BE CUT AND SOLD IN PARCEL PREPARATION? YES ❑ NO❑ Unknown at this time. TYPE OF JOB: EXCAVATION (] FILLING x❑ GRADING ❑x CUTTING 0 OTHER ❑ TOTAL SIZE OF PARCEL 58.59t ACRES/SQ FT SIZE OF AREA TO BE EFFECTED_27,20t ACRES/SQ FT ESTIMATED AMOUNTY OF CUBIC YARDS 155,470 cut/138,675 fill=294,145 C.Y.total DOES THE SITE HAVE SLOPES 14%OR GREATER YES x❑ NO[] DESCRIBE SCOPE OF WORK Mass grade of site,storm water system. WILL FILL BE BROUGHT ON SITE? IF YES,SITE ADDRESS: WILL EXCAVATED MATERIAL BE TAKEN OFF SITE?IF YES,SITE ADDRESS: DOES FILL CONTAIN POTENTIAL HAZARDOUS MATERIALS? YES❑ NO HAS A SOILS REPORT BEEN COMPLETED ON SITE?IF YES,INCLUDE A COPY. YES x❑ NO❑ WILL PROPSAL RESULT IN REDIRECTION OF ANY SURFACE W WATER RUNOFF? YES® NO❑ WILL WORK ALTER WHERE STORMWATER OF GROUND WATER ENTERS OR EXISTS THE SITE? YES© NO❑ WILL QUALITY,QUANTITY OR VELOCITY OF STORM/GROUND WATER BE ALTERED? YES® NO[] WILL THE RUNOFF BE COLLETED/CONTROLLED BY INTERCEPTORS,CURTAIN DRAINS OR OTHER DEVICES? YES© NO❑ WILL THE LAND BE REPLANTED UPON COMPLETION? YES x❑ 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® NO❑ OWNER/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 entitled 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 and Inspection.This permit/application becomes null&void if work or authorized construction Is not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTIPN.INACnvLiTY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X /y February 17,2023 Signajbre of Apple Date X Kimberly Savage OWNER REPRESENTATIV ONTRACTOR Print Name ,} DICATE) I-YI 0 - 1��1 4�-i 1 t) . Ur✓�/A