HomeMy WebLinkAboutGRD2019-00009 Cancelled - GRD Application - 9/10/2019 k°go�rcoo,��A MASON COUNTY PERMIT NO. 6 IL -UDc9
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y: DEPARTMENT OF COMMUNITY DEVELOPM
BUILDING•PLANNING•FIRE MARS.
WWW.CO.MASON.WA.US ( � Shelton ext.352
Mason County Bldg. 8, q, (360)27 Belfair ext.352
lrr;� 615 W.Alder Street, Shelton,WA 98584 (360)482-5269 Elma ext.RECEIVED
LAND MODIFICATION PERMIT (Grading Permit) SEP 10 2019
OWNER INFORMATION: CONTRACTOR INFORMATION rn1 5 W. Alder Street
NAME: PCI, LLC - POC: Dean Mauerman NAME: Not selected yet.
MAILING ADDRESS: 1415 College St.SE MAILING ADDRESS:
CITY: Lacey STATE: WA ZIP: 98503 CITY: STATE: ZIP:
PHONE: 360-280-0784 CELL: PHONE: CELL:
EMAIL: EMAIL
L&I REG EXP. /
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) 12328-2s-000 1 FIRE DISTRICT NMRFA
LEGAL DESCRIPTION(ABBREVIATED) :
SITE ADDRESS None tkTY Belfair
DIRECTIONS TO SITE ADDRESS From SR-3, turn es n CI o Rd Travel 600 ft, turn North on Roy Boad Rd.
Parcel is 1/3 mile up Roy Boad Rd where the Pav entturnsW gra0ei.
IS PROPERTY WITHIN 200 FT: None,wetland determina n rep p usl submitted to Mason County.
SALTWATER❑ LAKE ❑ RIVER/CREEK ND AND❑ SEASONAL RUNOFF❑ STREAM❑
- DOES PROPERTY HAVE SLOPE(S)WI _ F T OJECT-GREATER THAN 14% YES[ NO ❑
WILL TIMBER BE CUT AND SOL IN C L P ARATION? YES ® NO ❑
TYPE OF B• EXC VATIO LING ❑x GRADING® CUTTING ® OTHER ❑
TOTALS E OF PARCEL 10.0 es RES/SQ FT SIZE OF AREA TO BE EFFECTED 4.5 Acres ACRES/SQ FT
ESTIMAT D AMOUNTY OF UBIC��S 3000 CU Yards
DOES THE TE HAVE SLOPES 0 R GREATER YES® NO❑
DESCRIBE S PE OF WORK emove trees and stumps on the lower 4.5 acres of the parcel. Move 3000 rd of
material from side Ro Boad d to the W side of Roy Boad Rd. The slopes>15%will not be affected.
WILL FILL BE BR �MARTAf.
TE? IF YES, SITE ADDRESS: No
WILL EXCAVATEDBE TAKEN OFF SITE?IF YES, SITE ADDRESS: No
DOES FILL CONTAIN POTENTIAL HAZARDOUS MATERIALS? YES ❑ NO
HAS A SOILS REPORT BEEN COMPLETED ON SITE?IF YES,INCLUDE A COPY. YES [ NO❑
WILL PROPSAL RESULT IN REDIRECTION OF ANY SURFACE WWATER 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 ❑ NON
WILL THE RUNOFF BE COLLETED/CONTROLLED BY INTERCEPTORS,CURTAIN DRAINS OR OTHER DEVICES? YES ® NO❑
WILL THE LAND BE REPLANTED UPON COMPLETION? YES ❑ 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[J
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
INSPEC N. INACTIVITY OF THIS PERNRT APPLICATION OF 180 DAYS WILL INVALID ,eT�E THE A LICATION.
X 7�-�j/ — Z 7
&64aturerof Applicant Date
X Greg Mauerman for PCI, LLC OWNER IREPRESENTATIVE tONTRACTOR
Print Name ATE)