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Home My WebLink AboutGRD95-0021, RLC - GRD Application - 6/15/1995 GRID MASON COUNTY LAND MODIFICATION PERMIT Grading, Excavation, Fill, Slopes, Drainage Department of General Services 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT #1 Owner 1-2. -_'1:P?7GOA Phone# District# Site Address_CIE �CL�t 01 -E �'J City ,Qelf4,- St ugh Zip Owner Address /?0, e aX City [fe/{Q.� St Zip r Describe Work �XGu vaTc Fo`- /3yi/�i s .r."TL #2 Contractor Name e04_5T' Z`7 e. Contractor Reg # Address /?c Expiration Date s' l City "Ye/f-` St /,(��i Zip Phone # - �l #3 Engineer's Name i C/f �'I c C�ul�oug� Phone # Address City , / ,`, St U",6! Zip #4 Parcel No. /z 329 - Legal Description L D7_ 3 b SAD,-7— 107- / /�J �J /i�'e av IQ,Vj e //C�qr #5 Number of cubic yards to be excavated: Number of cubic yards to be filled: Number of cubic yards to be graded: S�� #6 Will this be a balanced cut and fill entirely within the site? Yes No `— If No: Will fill be brought on site? Yes No Where does imported fill originate from? L DT % Does fill contain any potentially hazardous mate i Is? Yes No #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? �'/oPC� T4 .ST CGT #9 Total size of area to be cleared el-e- acres/sq ft al,'e4ll C Size of area to be cleared on slopes over 10% AC/SF #10 Has a soils report been completed on the subject site? &0 If yes, include copy with application. #11 Is the subject site within 200 feet of a designated shoreline A16 #12 Does the subject site contain any of the following features? River Lake Wetlands Saltwater Slope greater than 15% Soft compressible soils Seasonal Runoff None #13 Will the proposed land surface modification change the points where storm water or groundwater enters or exits the site? d #14 Will the proposed land surface modification change the quality, quantity, or velocity of storm water/groundwater? /Yb #15 What methods, if any, will be utilized to minimize erosion and possible sedimentation into nearby waters during and after construction? S e(;,y P,7 ,tQI #16 Will this land modification result in the redirection of any surface water runoff onto adjacent properties? NO #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? C f #18 Will the land be replanted upon completion? V e,5 If yes, with what types of plants? e<,,,-C.1 7� �4lii�4 #19 Will this modification result in slopes steeper than those currently on the site? 0 If so, how steep? 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 EPARTMENT. DEPARTMENT. X OWNER X BY �i- DATE �/ DATE FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW Planning APP COND APP HOLD Building Environmental Other Special Conditions FEES Grading Permit $ Plan Review Site Inspection Violation Fee Other TOTALFEES $ Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Indicate Directional by (N, S, E, W) Name of Flanking Street in relation to plot plan Name of Fronting Street APPLICANT TO DRAW SITE PLAN BELOW APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW BUILDING PERMIT # DATE (j / 1 Is Planner Area 4 � - 90 � � CHECKLIST FOR PROPOSED CONSTRUCTION Yes No [ ] [ 7 Within 200 FT of designated shoreline, wetland, or associated wetland Where? [ ] [ ] Proposed construction on/over/in wetland Proposed construction within floodplain l \] ] Eagle nest State road access needed ] I ] Commercial Development (parking standards, sign ordinance, public works review, other applicable agencies) [ ] [ ] Mobile Home or RV Park [ 7 [ ] Exempt from building permit application I 7 [ ] Exempt from SEPA process (WAC 197-11-305, WAC 197-11-800) [ 7 I ] Meets all requirements (which section(s) of SMP does proposed construction pertain to?) [ ] I ] Variance or Conditional Use Permit required [ ] I ] Exempt from Shoreline Substantial Development Permit process (Wac 173-14-040) [ ] [ ] Exempt from Substantial Development, but within Army . Corp. jurisdiction (WAC 173-14-115) I ] I ] Address needed [ i D-rcct.ic�, I Date Received: MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT RESOURCE LANDS AND CRITICAL AREAS CHECKLIST The following checklist is designed to assist an applicant for a Building Permit, On-Site Sewage System Site Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Line Adjustments, Land Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affected by regulations under the Mason County Interim Resource Ordinance f77-93J". This checklist is an important opportunity for identifying early in the permit process whether there will be any environmental regulations affecting the proposed development. Owner A/aC��l11 Phone #( -,64) Site Address N ,�3-3`s�/ s 3 City Zip Owner Address "ad City /=A/2 State�z,;b Zip Tax Parcel No. (Confirm with Assessors Office) A k.-)- J - !V3 _ Legal Description_ L&,t-> F �lcl Sfc 9 %wN.,% R1 by u0.i'I !oT 3 s�a«70// /817 61 Project Description -NErcJ Or n F G b Directions to site (Please attach map) lt'C o f> e- i QEg 1=Leon' T r Al G rc) C' ►� �, k R a� h�cvV 3 Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc. Answer the following to the best of your knowledge. County-wide maps showing general locations of critical areas and resource lands are available for review at Mason County Department of Community Development, Planning U..oNY Department. — Do any of the following exist on this property or within 200 feet of this property? county ❑ 1. Saltwater shoreline or a lake 20 acres or larger? ❑ ❑ 2. Rivers, streams, or creeks with year-round flow? ❑ ❑ —C 3. Rivers, streams or creeks with intermittent flow but are within a clearly defined channel? ❑ 4. Lakes or ponds less than 20 acres in size? u ;J AN 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstances support vegetation adapted for life in such conditions; such as marshes, bogs, and swamps. (See County Maps tar guidance.) El J �iida Ater than t reEs)?"(See the Co Qfle�i'and Erosion Hazard idlaps for nce. dplains? , ee County Federal Emergency Management Maps and County Seismic Hazard Maw__ auldarIGUA ❑ �( 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic Hazard Map for guidance.) You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any of the following programs: Covxr Ym He ❑ El1. Agricultural Open Space Taxation Program, RCW 84.33 ❑ ❑ 2. Open Space Timber Taxation Program, RCW 84.33,or Designated Forest or Classified Forest, ' \ RCW 84.34 RESOURCE LANDS & CRITICAL AREAS SITE PLAN PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE: . Location&dimensions of existing &proposed property boundaries. . Approximate slope of land (grade &direction),topography. . Identify legal access including, width of all road right-of-ways&easements. . Location of significant natural features(water bodies, rivers). • Locate all existing &proposed structures,drainfields, wells &driveways. . Project description Scale 1"= North Arrow i 1 state that I have answered the above truthfully to the best of my knowledge. Applicant/Owner Date FOR OFFICIAL USE ONLY Adjacent property. I _ i Using County Resorrce Lard Maps, this property is designated as: i, Lung.terrr. Commercial Forest _—__4" Shoreline Master Program 2. t;,li !:'i(; ; Land DoeS not apply. 3. P.IinUral Resource Land t�3te DCD There Is a $40.00 application fee for the Resource Land& Critical Areas Checklist. Make checks payable to the Mason County Treasurer. Wha completed, this form becomes part of the permit application. J MASON COUNTY DEPARTMENT of GENERAL SERVICES Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton,Washington 98584 (360)427-9670 BUILDING PARKS& RECREATION FAIR/CONVENTION CENTER ADMINISTRATION PRE-CONSTRUCTION MEETING REQUEST APPLICANT: EARL LINCOLN PROJECT: OFFICE BUILDING, BELFAIR, NEXT TO CREDIT UNION. MEETING DATE : FRIDAY, MAY 19 , 1995 MEETING TIME : 9 : 00 AM MEETING PLACE : MIKE BYRNE OFFICE PLANNING: GRACE MILLER HEALTH: JOHN DENISON BUILDING: MIKE BYRNE FIRE MARSHAL : DAVE SALZER