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Home My WebLink AboutGRD2004-00004 Raise Grade, Asphalt area, Revised Drainage Parking area 3parcels - GRD Permit / Conditions - 9/2/2004 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 IPO Shelton, WA 98584 LAND MODIFICATION BUILDING PERMIT GRD2004-00004 OWNER: Chester Loudin RECEIVED: 6/7/2004 CONTRACTOR: LICENSE: EXP: ISSUED: 9/2/2004 1 ENGINEER: LICENSE: EXP: EXPIRES: SITE ADDRESS: PARCEL NUMBER: 123174100060 LEGAL DESCRIPTION: TR 6 OF NE SE PROJECT DESCRIPTION: DIRECTIONS TO SITE: Regrade existing asphalted area by raising grade. Also included is some drainage revisions and new parking area Inspection Area: Fill?: Comp. Plan Desig.: Rural Grading?: IRO Desig.: Cutting?: Shoreline Desig.: Not Applicable Area Graded: SEPA?: No Cubic Yards: 300.00 FEES Type By Date Amount Receipt Public Works Review AT 6/11/2004 $39.22 S12004000 Grading Permit Fee TLG 8/30/2004 $72.00 S12004000 Grading Plan Check Fee TLG 8/30/2004 $37.00 S12004000 Total $148.22 GRD2004-00004 Please refer to the following page(s)for conditions of this permit. 1 of 4 427-9670 MASON COUNTY BUILDING DEPARTMENT ALL PERSONS ARE HEREBY ORDERED TO AT ONCE TOP WORK On these Premises at This order is issued because A.M. Posted P.M. 19 By The failure to stop work, the resuming of work without permission from the WARNING Building Official, or the removal, mutilation, destruction or concealment of this Notice is punishable by fine and imprisonment. INVESTIGATION REPORT FORM Revi�d 10/6/94 r) Part A: Nature of Complaint • Initiator's Name: • Address: • Telephone: • Owner Name: O(1 d/ • Address: • Telephone: • Department of Concern ❑ Clerical ❑ Building ❑ Health ❑ Comm Development ❑ Fire • Area of Concern: (V 1 ❑ Process Delay ❑ Personnel ❑ Policy/Fee ❑ Code Violation ❑ Other \ ) Refer to Director • Location of Concern: r z z C) • Natu e of Conce , � J n N, 4 Part B: Concern Intake and Referral RV2M Referred To: Response Date: loD Na e Date Name Date Date Part C: Findings Referral Forwarded to: ]~:& 9'- oG ❑N/A Name Date Findings: 7'-c-> SiG h/T 4r `�' 6-Od gr7rycy T/o 'X 1� Z k,,,f f — pc,or ppc. lfS w��4+r E +I�E d� /mow r yycyl- V L _W 2 e-c c,•- j'wv 4.�12/ dL /c/GG /i✓� /v ly�% -�fyOJ'. Part D: Resolution ' Name Date Intake Copy-White File Copy-Yellow Referral Copy-Pink u7 z r� - - - -- -- Gj ------- ----- v� �S 'r P L0�d,� r Led A!C -� d gam( i31� - W OIC Yeti,D 6.4— — y —----------— - - - - - - - � A" 61) - - Zo6D f— -- !::!--L sl-� t I to TAX PARCEL NUMBER: OWNER: Tfu s s VIOLATION: �bl.,,.�k . ..... STATUS: DATE: U Z --------- SITE VISIT NO ES: ces Z f V'� - % jS7 1 op ern- r 7 3 45 7 J PORTION NE yOFSE4 39:3159 SEC 17 -TWN 23N RGE I W "17:3rw :31s ti O F< O T s Q �rrrw�•s In �r.r ow h N i t Ql,/N fR S 3 O In o Wo1FGAK6 v.*tluatTH A rn M,t.LER i 5T,RT.3 Qax 390 Ge DrAi it WASH. 98529 Short Plat 'N..ID-96 �ArlD f.:.sMrRLtr ,(ArNES V I 3 7 616 ? SAPICO TtTLI 1wlVAA1.Ca Ccli r CX ?I11240 11. •')8 3 SAFE.a.a /`7 �. / TNII a•ACI AISIMV IO.OP AICOAoleal Val t,- Fried roe N.oee4 at N.our.t of / 3 5.0 f Jif�l�l NAME Reid Realty I / P. 0. 303: 583 ADO R E5.4 �;. CITY ANO STATE Balfair, ;tA 0352S .� Ul: Jon C.IdY EASEMENT taJcizazsast DEED LAND TITLE COMPANY ` THE GRANTOR - MARGIE J. STEYENS .. fa,nd In com+d«anon of Easement can.evt and ou,I cla,rtwm DANIEL H. LASLEY and DONNA ELEANORE LASLEY, his wife; and WOLFGANG Y. MILLER and JUDITH K. MILLER, his wife _ '<4 me lollo_nq I)eycnlyd real Hole,%,[Wled in IM CountY of Mason ' State of W.~Caton.Includ,rq anv tart a .,ed title. An easement for ingress, egress and utilities lying 15 feet an either side of the C J foilowing described line: A tract of land in the Northeast quarter of the Southeast quarter of Section 17. Township 23 North, Range 1 west, M.M., in Mason County, Washington, more Particularly described as follows, tp wit: BEGINNING at the Southeasterly corner of Section 17, Township 23 North, Range 1 west, W.M., in .Mason County, Washington, proceeding thence along the East line of -� said Section 17, North 1' 05' 46" West 1686.33 feet; thence West 1235.61 feet to the Easterly margin of Old Navy Yard Highway; thence !forth 42' 35' 12" East 258.04 feet to a point herein denominated Point "A"; thence continuing along said Easterly right-of-way line of said highway North 42' 35' 12' East 21 feet to the TRUE POINT OF BEGINNING; thence Sautheastarly at right angles to the said Easterly lint of said highway o a point of intersection with a line which bears East from said Point "A"; thence East 400 feet to the terminus of said line. CAVrr (Wren Da,b iT/i 9 �t� E X E M P T �f ?/)•,a '� MAY 2 1960 • • / l undl.,du.rt 0t1R[NE AAE Ilnolrldur) IPr nldmll tr,•t_ +rte" BY .. ISacr.tarV I i STATE OF WASHINGTCN �ask STATE OF WASHINGTON (` COUNTY OF t*i COUNTY OF 0.Ih day o *Iv apped bald.nr On tn,. d.v o1 `.q itn_0at $^are. 19_,before me,the und.rugned,a NOtwY Puellc In end fa the State of W.lmngton.duly m ,-oned and lveorn, ' to ma to to be the and Mid oerton.11y aooe.r.d a.a(Viad the thM and forpane IMtnu",and K1noM- -t: so" that T and " Prendent „*,b rrla tune,. to me tnown m a me T free and votuntrr oin and deed.is m.utea and ouroo e'a and S—tary.retoec11re4y.of ` therwn menuorwd. 1".(oro—tldn Ih.t.—I.d In.for.gang Inllrum.nl,and 1, GIVEN U,.W my Mend end oIfiCi40 NM myil� KkMo+d.d9.d the old IMlrumenl to be The Ira.and rol., day of /"t� 19 1_ tart Kt and deed of old corddallon,for the.1«and cuf- - PtMt thupn mMtioneo.and on oath aalad that Wthorltad To..Ku11 the taltl imInjment and that IM fe11 a1fi..d it Ine ccroo,et.val of Notary Public in and fof Ina Sutr of Waw11 r1et1Y1.Imdlnq aid coroonuon. In ' - Wllnm mY nand Intl olllap gal nvew Hfr.ed the dar and weal IIf1I Ibor1 Mlitan. Notary P.W.c in.oa for the date of`.Vath,rgto�,—d-q MAY 2 1980 at I \ t LA= Tnzs Ca""y OF MMON covN71% 930 W Fan_nnAD AVS. D.O. BOX 327 S=LTCN, 1068X=NGTON 99584 Q Q (360) 426-9288 (800) 955-0852 I � LAYm Z �'ITL3 CANY 03tDs3t PTO. _ S1C8TC3 OF DRCDSRTY SIM CUT 33 AT',A® ORDER To assist in locating the premises. It, is mot based on a survey, and the ccmpany assumes nc liability for variaticns, it any, in diaensicns and y locations. NOTE: This map does not purport to show ALL highways, roads or easamants affecting the property- —PLY S- 1 143 41100 'ice ,a?a •,9� ;A �� 4 1 90 4201010 4201000 'ice S s �pAJ 02C 4201020 %090 OC sopjO 0J J3G 3 i3 Qll /S92 01 41C0 4190110 04a 4100 —t` 013C 4;CC0!0 �1 4 4290 030 4'COCoC 429CO20 11 0 3 C O I O �\ 1 I 4{30 41 3CO70 ----- ---- \ \!` 20 SR 1025 — _ 410CCOC 4-150 y'o0 IIC 120 S 1/J2 4390 ICa 4230020 430C 070 S? 1800 44CCCCC 42CCCaC S l/32 5 21112 42CCC80 430 J9a 4300 5 1152 040 a3C0 439CO2C OLJ / l 8__.=4 /R UNION tiw� a:vS.-? 37616 , YeaCO TrTLII INAJn ANCa COWIIMY �a,(�+� �,r11240 I,. !)83 OIL /`� �., / TwIa.IACa n7]anv a0 ran naC On Ol1l7 Vat {Ibr fd geoord.a Itettue,t of SO 3 (11U ova are NAAeE Raid Realty ADDRESS P. 0, 3oa 383 �;. CITY AND STATE Belfalz, AA93529 Attn: —j6F-U1 EASEMENT CL=rL1CIi0EED LAND TITLE CO;APANY ` THE GRANTOR - MARGIE J. STEYENS for rasa M cww d«.tlon al Easement opr,a.eY„nd oulf cl.Ima to DANIEL H. LASLEY and DONNA ELEANORE LASLEY, his wife; and WOLFGANG Y. MILLER and JUDITH K. MILLER, his wife '`� V,.Iollowwlq tNsr J.ltl reN a f..„ha.led In the C—h1Y al Mason W SI.le of WaaAwq,on.Intl,ldlnq WY alias lcpuued title: i An easement for ingress, egress and utilities lyinq 15 feet an either side of the following described line: A tract of land in the Urtheast quarter of the Southeast quarter of Section 17, Township 23 North, Range 1 West, tiny., in Mason County, Washington, more particularly described as follows, to wit: BEGINNING at the Southeasterly corner of Section 17, Township 23 North, Range 1 West, W.H., in .Aason County, Washington, proceeding thenl:e along the East line of }( said Section 17, North 1' 05' 46' West 1686.33 feet; thence West 1235.61 feet to the Easterly arrgin of Old Navy Yard Highway; thence North 42' 35' 12" East 258.04 feet to a point herein denominated Point 'A"; thence continuing along said Easterly „fight-of-way line of said highway North 42' 35' 12" East 21 feet to the TRUE POINT OF BEGINNING; thence Southeastariy at right angles to the said Easterly lino of said highway 0 a point of Intersection with a line which bears East from said Point "A-; thence East 300 feet to tho terminus of said line. Al-�C/I�pAVI— sal f,taR EXEMPT o e.A / f 9�t� �/ �)•ii '� C xc��_ MAY 2 i°60 / I ��Ind,.tdoa(1 f BV p()RCVE ZAE Ilnd,rlw.11 IPnud.n❑ Tn.,.. �.+�^�m eY — Is«ra.,,l i STATE Of'NASHINGTON � STATE OF'NASHINGTON COUNTY OF M..a,} COUNTY OF Itl. on thl,d.Y oNwn IV.OW6r9d tolm. ne On thll d.V at ,._d-.., 19_,betorf m.,eM und.rugn.d,.Nota,v PublIC In.nd i fo,the state of'NaY,Ing,on,duly mmminlon.d and l0 Rae kIW,.,, t0 b•the I,W hltllaal OICIatl In.IW wnq per wnellY 10 D.at.tl {� ...,.d U+._d%..ntl fo,,".hq,httf.and.C►h0M1- `1: .oge0 the ugned the t.,,le Is •- to m.knoren to d tM P.eid.nt i I—and.dun,.e•r 1n 1no oe.d,ip,'n.u,.,arw purpose, and S.aetary,repK:lrel Y.of -4 ther.ln_von.d. t in.corpar.tlon tn.t I.Ku,.tl the for egpinq Instrument,Ind 7 _ GIVEN und.r mY h.nd.nd oM040 N.I'hit'�'' .cxh.r .dq.d in...d n(uumsnt to be in.Ir..and.1t 1 d-al Mn^ )9 1 tary act no d..d ofd corooratlon.for tM u,.,and our ) oo therm mehtlontd, no on oath listed the wlihorlf.d to rt.cut. the laid Fn,trum.nt and tMl IM tea alli..tl 4 the corporate a.el of • Not.rV Pub11C In and to,the State of N1tlunron,!mdtnq told co,00rabon. Wllneft mY hand and ollietal tad hereto aifised the d"and t' Y.0 lint fbore rnitt,n. i No,4 end br fine Sate ,i•Aa,h nrt .m dq MAY 2 Icgp f � OF SE4-PORTION NE SEC 17 —TWN 2 3 N RGE I W �_«�;:3 tH j10 ,�-- .. 0 F�F o ti Y l a - LA � c 3 0 WoLFC,Ar4 V..4 z TH A rn MILLER sr. ,eT.3 3ax 390 Short Plat 'r_LN 6 MAVID ,eR/NES I � 1 04 220 Rural Residential 5 (RR 5) 1,04.2.21 Purpose, This district provides for residential development on parcels of 5 acres or more. 1,04,222 Uses Permitted, A USES: Single family residential Hobby farm (Small scale commercial agriculture. including aquaculture and wood lots). Church. Local community and recreation centers. Group homes. Cell towers. Fire station. Fish hatchery, Public utilities. B. ACCESSORY USES: Cottage Industry (home occupation). Single family residence. C. SPECIAL PERMIT REQUIRED USES: Essential public facility. Schools commercial day care centers. Home occupations and Cottage Industries that do not meet the standards in Section 1.03.021. 1.04.223 Lot Requirements. A. Density and lot size. Maximum of 1 principal residence per 5 acres or 1/128th of a section and one accessory dwelling unit per parcel: minimum lot size of 2 acres. except in an approved performance subdivision the minimum lot size is 20.000 sq. ft., and except for fire stations. B Lot width and depth All lots shall have a minimum average width of not less than one-third of the median length and a minimum width at any point of 50 feet. C. Front yard setback. 25 feet D._ Side and rear yard setbacks. Side and rear yard setbacks for the residential dwelling is five feet, for accessory buildings shall be five feet, for accessory structures used for agricultural purposes or home occupations shall be 50 feet, and for buildings of non-residential land uses shall be 25 feet. E. A lot created by short plat, large lot or long plat subdivision which is restricted to special purposes. such as storm water storage, community play areas or utility facilities, and is restricted by oeMetual covenants meeting county requirements to said puroose, is not required to meet minimum lot size requirements. 1,04.224 Building Regulations. A. Floor Area Ratio. 1:20, except for fire stations. B. Size. 3.000 sq, feet maximum for non-agricultural and accessory buildings except for dwellings and agricultural buildings. C. Height. 35 feet except for agricultural buildings_. cell towers, antennas. or water tanks. 1.04.226 Off-street parking. Two spaces per residence. See Parking Ordinance for other land uses: parking setback for non-residential land uses shall be 25 feet. 1.04.227 Special Provisions. A. Cell towers shall be located per Ordinance No. 5-98 Telecommunication Towers. B. Accessory dwelling units are required to meet Section 1,03,029 standards. C. Government operated day care centers, essential public facilities, community centers. and schools may exceed 3,000 sq. feet as approved by a special use permit. MASON COUNTY DEVELOPMENT REGULATIONS,ORD.82-96 J:K;MSHAREIDEV-REGS1200/ID-REGS02.DF4 MAR(---"S. 2002 NEW TEXT,BEbEfF9 TEXT PAGE 41 I RATIONAL METHOD RUNOFF ANALYSIS (Ref: Civil Engineering Reference Manual 4th ed.,by Michael R.Lindeburg,P.E.) Qp=C x I x Ad C=Rational method runoff coefficient I =Rainfall intensity (in./hr)=Vday(100 yr)x 1 day/24 hrs=0.31/hr per Puget Sound Stonnwater Manual,Appendix AJII-1.1,p-0-1-46 96.3'Et.at grate Qp=Runoff,cubic feet per second ?4. 7680 sq.ft. culvert 92.8'B.(bot.of 18"cult') Bank ed are \ "' /2z' 4U x 80' x 95 EI. w -------------- f--------------- Catch Size, Rational Method A■ yo?�o 96.)0'fit\■ B « ad ■C 3 ;Proposed drainfield Proposed drainfield tia e g ---------------- u, basin acres coefficient.C I- op.cfs --------------- %� A .184 0.95 0.337hr .058 �o ;p• N x 118'B. x 114'EI. Proposed easement for drainfield B .115 0.95 0.33 .036 •Wall x -preserve Wall x EI. 96 8. x 87.8'B. x 87.6 El. C .161 0.95 0.33 .051 Q x D .161 0.95 0.33 .051 D■ E� 54,700sq,ft. E ■F x 104.9El t E .271 0.95 0.33 .085 ed ardA, ;; o c H „ x 93.T TEL a F 165 0.95 0.33 .052 x 92-7 B. 9Q.6 El. ' E; _ E Bank G .124 0.95 0.33 .039 m Parcel#12317�41-OM H .177 0.95 0.33 .056 50 x 10 ao U X x 86.6 B. x 8T El. 1 .293 0.95 0.33 .092 100 x 1.8'EI. ad 411!" ' ■C3t� H J .293 0.95 0.33 .092 truss factory x ¢9.3'EL!; x 5 El. _____________ik __ I 18 x 8T El. Consider"socced"culverts to increase Infiltration and decrease flows C.2qU 3W ) 600' 700' 800' 900' 1000 x 94.2 Et. x 90 B. X x VUEmergency Vehicle --=- ---------ale drainage ditch ---- x 85.3 El. .. \ `. " d x 86.2 El. x 86.6 058 cis B -------- +r Cm A■ -----=- X 90.5'EL r-�t-------- ------ <--��------i , ■ I 1 �' i tC i x EI. ; \ j .``.` b ---ofs F 3i 22,500sq.ft. oivwater I x 83.5 I. wed area ; manta" •, cn can increase size of retention ponds x W EI. 100' E X Q i ofo' � 4E. of CD s tZi ' m CD a 0 x' o�� 1r H Qo 8� i 0 omi G;' ■J \ i n x ; Union River / X 88'B. 84 x 88' I !---------------- -- j Q ----- - 092 cls 190' I ■=-------r 835.61' I 1 � I 1 1 � 1 09r��G I � W c J■--------T------ --' Compute amount of runoff for a 24 hour storm event for the paved area: From the above flow diagram: Total 24 hr vol.=(.269+.162+.092+.092)cu.ft./sec x 60 stm x 60rrrlh x 24h/d = 0.165 x 86,400=14,260 cu.ft Compute total volume of settling pond: PERMIT NO.: GRD rzL MASON COUNTY LAND MODIFICATION PERMIT APPLICATION C �CX� 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner �_ , r. Contractor Name Mailing Address _ Mailing Address City ;' 1 t ✓ State a Zip Code i City State Zip Code Phone .f c -'. `lti1 .,,Other Ph.( Ph.( Other Ph.0 Lien/Title Holder t- t Contractor Reg. # Address El I It ? I , S u.>. r o- Expiration ENGINEER INFORMATION Name Phone (� Address State Zip Code PARCEL INFORMATION-12 digit Tax Parcel No. I -2, 3 17 / z-i I / 6DD D Fire District Legal Description , - -,7 ,,.,ie& .cn� ikP9s4 6.u.4t4e,- S«F10117 ia.J..,-23 ma,11, /tjnsC I w.c i- Site Address(include street name and city IOfRO D U 12,,Ai— 9 ae 48S"l.D Directions to site: 2 M i I t S -wg> ,.% S-f o e Sf 4 1 1 ti A'e 14i Will timber be cut and sold in parcel preparation? (Yes/No) V0 Is your property within 200' of the following: Body of Water(Name) Gt.�/Wj fZ(�ey Saltwater Lake River/Creek c.,,l Pond Wetland Seasonal Runoff Stream Slopes or Bluffs Soft compressible soils TYPE OF JOB - Excavation Filling Grading Total size of area 000 Size of area to be cleared on slopes over 10% Estimated amount of cubic yards Describe Work �erl7o✓t ,ti, r�►z Ail LAND MODIFICATION INFORMATION YES NO Will fill be brought on site? If yes, source KIJ S4 R tcbA M4 (O^J Will excavated materials betaken off site? If yes, destination Ki fse ll= ik ec la-,,a d J 0 ) Does fill contain potential hazardous materials? 13 0 Has a soils report been completed on site? If yes, include copy. E 0 Will proposal result in redirection of any surface water runoff onto adjacent properties? 13 0 Will proposed work alter where storm water or ground water enters or exits the site? 13 18 Will quality, quantity or velocity of storm/ground water be altered? 13 13 Will runoff be collected/controlled by interceptors, curtain drains or other collection devices? 0 0 Will the land be replanted upon completion? 0 13 Will the proposal result in slopes steeper than those currently on site? 13 Is the site within 200' of a designated shoreline? 0 a NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a the Contractor Registration Law RCW 18.27 and am aware of the contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work ordinance requirements regulating the work for which this permit is issued will be done in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall first obtaining approval. be made without first obtaining approval. X Date ! " X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Sub ittal Amount D e Receipt No. DEPARTMENTAL REVIEW KftoVED rf k o CONDITION CO Building Department / Planning Department Public Works Department Fire Marshal 1 F ES Grading Permit Fee Site Inspection Plan Review Fee Other LPublic Works Fee Pre-Paid at Submittal ( ) on Fee TOTAL FEES FORM MUST BE COMPLETED IN INK , PLEASE PRESS HARD PERMIT NO.: GRD MASON COUNTY LAND MODIFICATION PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone( ) Other Ph.(____) Ph.( Other Ph.( Lien/Title Holder Contractor Reg. # Address Expiration ENGINEER INFORMATION Name Phone (� Address State Zip Code PARCEL INFORMATION-12 digit Tax Parcel No. 1 7 / 1 / now &4 Fire District Legal Description .'.,1.: CIIV A,In- See i i_ 1-2 1- .;....�;, ,.,.•,.�� 1 �� I- Site Address(include street name and city JgRQ b fl ae jbi, ur,r j2.1IA„- JIA- Directions to site: _'1o,,,a Sigg,, , 'U t ,./ a,to,, Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water(Name) Jrf Al(O.J P,c1l w Saltwater Lake River/Creek e., Pond Wetland Seasonal Runoff Stream Slopes or Bluffs Soft compressible soils TYPE OF JOB - Excavation Filling Grading Total size of area Size of area to be cleared on slopes over 10% Estimated amount of cubic yards Describe Work LAND MODIFICATION INFORMATION YES NO Will fill be brought on site? If yes, source13 a Will excavated materials be taken off site? If yes, destination 0 0 Does fill contain potential hazardous materials? 13 Has a soils report been completed on site? If yes, include copy. 0 0 Will proposal result in redirection of any surface water runoff onto adjacent properties? a 0 Will proposed work alter where storm water or ground water enters or exits the site? 13 0 Will quality, quantity or velocity of storm/ground water be altered? 0 0 Will runoff be collected/controlled by interceptors, curtain drains or other collection devices? 01 13 Will the land be replanted upon completion? ® 0 Will the proposal result in slopes steeper than those currently on site? 1 Is the site within 200' of a designated shoreline? 1 NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a the Contractor Registration Law RCW 18.27 and am aware of the contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work ordinance requirements regulating the work for which this permit is issued will be done in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall first obtaining approval. be made without first obtaining approval. X Date �' 4� X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES I Building Department Planning Department Public Works Department Fire Marshal FEES Grading Permit Fee Site Inspection Plan Review Fee Other Public Works Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES