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Home My WebLink AboutGRD95-0048 Cancelled - GRD Application - 12/4/1995 r V SIN NOUN ROND DES DT.- NOVEMBER 17, 1995 TO: ALAN TAHJA/PUBLIC WORKS FR: CHRIS77AE HERTH/BUILDING C'J� RE: LAND MODIFICATION PERMIT FOR KENNETH A. VANBUSKIRK AT YOUR CONVEYANCE COULD YOU REVIEW THE FOLLOWING APPLICATION FOR LAND MODIFICATION FOR COMMENTS AND CONDITIONS. WHEN COMPLETED PLEASE RETURN FILE TO BUILDING FOR COMPLETION. THANK YOU IN ADVANCE. D MASON COUNTY GRDgS OCT 2 5 .1995 LAND MODIFICATION PERMIT Grading, Excavation, Fill, Slopes, Drainage '-k�A{ '�` �!r'! �11y�� '�` Department of General Services ~�[77 6�W`Ledar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT #1 Owner /KeAbV M A• A4NBaSK/AA-.— Phone#;2 Fire District# Site Address ME <D 811 SAND gjtL AvAli City 8,64641,y- St W-4 zip 98-s a8 Owner Address iV�,3/ P.*11S FR,Qi7 Xmj> City get-64/-0-- St !NA` Zip 9RS-a 8 Describe Work cSiT o S c T #2 Contractor Name t -F Contractor Reg# Address Expiration Date City St Zip Phone# #3 Engineer's Name S Phone# Address City St Zip Parcel No.la320 - 3 - ObG/D �'� < C'f LA)-t Legal Description Lie weS� `Ia�'`�� ( Tn� /✓�'j"7'� �3Ci1 sc� iy�� Sw YY s E av� Ta3lI; A21&t� "w#5 Number of cubic yards to be excavated: -� Number of cubic yards to be filled: < c2 Number of cubic yards to be graded: #6 Will this be a balanced cut and fill entirely within the site? Yes No f If No: Will fill be brought on site? Yes ✓ No Where does imported fill originate from? c.[._ X014D l2 b T l 1( L VQ I - &bl"c g Does fill contain an potentially hazy s materia ? C Yes o 7 #7 Will excavated materials be taken off site?Yes No If Yes: Where will excavated materials be taken? #8 Briefly describe existing terrain, vegetation, and improvements on subject site? S 'ay Cy &"- .<ro o #9 Total size of area to be cleared acres/sq ft Size of area to be cleared on slopes over 10% AC/SF #10 Has a soils report been completed on the subject site? ZZ If yes, include copy with application. #11 Is the subject site within 200 feet of a designated shoreline A10 kA #12 Does the subject site contain any of the following features? /nel �'River Lake Wetlands Saltwater yydM 1-1,5r Slope greater than 15% Soft compressible soils Seasonal Runoff None f #13 Will the proposed land surface modification change the points where storm water or groundwater enters or exits the site? //6r c. wCcJ d�POW r..�ykc�i ✓uH+ r #14 Will the proposed land surface modification change the quality, quantity, or velocity of storm water/groundwater? N U if #15 What methods, if any, will be utilized to minimize erosion and possible sedimentation into nearby waters during and after construction? #16 Will this land modification result in the redirection of any surface water runoff onto adjacent properties? Alo #17 Will surface or subsurface runoff be collected or controlled by interceptors, curtain drains, or other water collection devices once this land modification has been completed? N s #18 Will the land be replanted upon completion? YES If yes, with what types of plants? F— �� #19 Will this modification result in slopes steeper than those currently on the site? 0 If so, how steep? Show following on the site plan Lot Dimensions 33o`l qay Flood Zones Existing Structures Fences )cXX r Structure Setbacks Driveways —' Water Lines Nho —'! Frirewlirwz Drainage Plan Topography Septic Systems Wells W Proposed Improvements Easements.-- Indicate Directional by (N, S, E, W) Name of Flanking Street in relation to plot plan Name of Fronting Street PJc logo MN D ►�II ��{m,� APPLICANT TO DRAW SITE PLAN BELOW yZy, 211 330 _ I JL- APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS IN- SPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNER X BY DATE �G' c� I S DATE FOR OFFICIAL USE ONLY:Accepted by: Date: Qq r S" ' - -- - - --: ---- - ---- -------------- ------------ -- - -- -- DEPARTMENTAL REVIEW Planning APP COND APP HOLD Building Environmental Other Special Conditions z- Q FEES Grading Permit $ I l Plan Review 2— Site Inspection Violation +Fee Other(`��r c I C1 t TOTAL FEES $ Page No. 1 CASE HISTORY FOR CASE NO.: GRD95-0048 KENNETH VANBUSKIRK ............... 12/04/95 Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By GRDA010 Application received / / / / 10/26/95 10/26/95 KW GRDA040 RLC Checklist Review / / / / 11/01/95 DONE HRF 11/01/95 TMJ GRDA100 Building review 11/21/95 / / 11/30/95 applicant has cancelled and will apply CANC TLG 12/04/95 TLG at a later date GRDA120 Engineering review 11/17/95 / / 11/21/95 PER REQUEST OF THE BUILDING DEPARTMENT I DONE AAT 11/21/95 TW SENT THIS PERMIT TO ALAN TAHJA FOR REVIEW. RETURN TO BUILDING WHEN COMPLETED WITH REVIEW PLEASE, THANKS CPH GRDA560 Permit cancelled / / / / 12/04/95 as per Alan Borden TLG 12/04/95 TLG