HomeMy WebLinkAboutMEP Application PERMIT NO.
DATE RECEIVED
P►1't'�j (I L^.t
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
INTERIM RESOURCE ORDINANCE (Chapter 17.01 MCC)
Courthouse Annex III, 426 W. Cedar/P.O. Box 578, Shelton, WA 98584, 427-9670/1-800-562-5628
ENVIRONMENTAL PERMIT APPLICATION
The purpose of the Interim Resource Ordinance is to protect Mason County's natural resource lands and critical areas and
is under the authority of Chapters 36.32, 36.70A, 39.34, 58.17, 76.09, 84.33, 84.34, and 90.58 RCW.
PLEASE PRINT
#1 Owner Phone#�3(06�21D h �
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Site Address 2 35b l �.{. { i-}W >�3
'Z Fire District #
City 'b eLi-f-'x n- State WA Zip 9852 6
Owner Mailing Address T ,0 + U k ) Z3 Qj
Ci*y State \AIA Zip 9 35Z8 -1238
Lien/Title Holder K 1TS A'P UArll<
Address
City State Zip
#2 Parcel No. 1 z 3 2q - L4 3 - CAD 12r0 Legal Description `r12 12 sw fit•''
LYr>~ DR�ti. + 2 'J 2a -�t 3 - 0 I(9 O c i tJ 1= Sw
Parcel Size#3 Directions t ite lease attach map) +ck 9k 3 a(/w CreA,f' (,(a, ,q
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#4 State what Sections required a permit:
Long-Term Commercial Forest, Chapter 17.10.060; _ Inholding Lands, Chapter 17.01.062; — Mineral
Resource Lands, Chapter 17.01.066; _Wetlands, Chapter 17.01.070; _ Critical Aquifer Recharge, Chapter
17.01.080; � Aquatic Management Areas, Chapter 17.01.1 10;
Geologic Hazard Area: _ Frequently Flooded Areas, Chapter 17.01.090; _ Landslide Hazard Areas, Chapter
17.01.100; — Seismic Hazard Areas, Chapter 17.01.102; _Erosion Hazard Areas, Chapter 17.01.104.
#5 Identify current use of property with existing improvements: �XUDIN IN ?P(►21<I N& L bi
C-A-A-\ Lc)T W t'1--r} e.►2i-e1LCWKKA is "ow A W-ty+DvsL`t RAN
�RD A 12' LU1,Ve&4 -tiP++ WET UNWL CA 1� J "" LOT • 0; e qt^%+--to yst
ELIMI`l(A LL-VE1 d 22VER.i FI-OW 'Tp 141sW W -Ve+2T L,)NE - Oy`C DES)
#6 Identify and describe the proposed project, including the type of materials to be used, construction methods,
principal dimensions, and other pertinent information (Attach additional sheets if needed): DI& �
- I tQ ST PP �,vCQX
1P1N INSTALL —N1=R- q 0) A e�x OP C.VvvetT
CA'TC.rt %M,t4 43' x b'IU' Cti3' F2or*, 4 LU,(V#A +wE l DUE 4 S7 Faoyn
150' 'FT O v F- W ASS oJ- N e'w )-y' c.v t_v&ri- �At
#7 Any water on or adjacent to property: Saltwater_Lake_River_Pond_WetlandSeasonal runoff
Other
#8 Will there be an alteration of a wetland and/or wetland vegetation areal _Yes -�(No
#9 If septic is located on project site, include records.
Connect to Septic? Community Septic? Public Water Supply? Well?
#10 Type of Job: New_) Add Alt Repair_)L Demolition Other
This permit is granted pursuant to the Interim Resource Ordinance (Chapter 17.01 MCC) and nothing in this permit shall
excuse the applicant from compliance with any other federal, state, or local statutes, ordinances or regulations applicable
i r to this project, but not inconsistent with the Interim Resource Ordinance. The permit may be rescinded pursuant to the
event the permittee fails to comply with the conditions of this ordinance.
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic System Wells
Proposed Improvements Easements Indicate Directional by (N, S, E, W)
Name of Flanking Street in relation to plot plan.
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DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Camnnents
Planning:
Environmental Health:
Building Plan Review:
Occupancy Group:
Fire Marshall:
Other:
Conditions: FEES
TOTAL FEE
Accepted by: Date: