HomeMy WebLinkAboutMEP2003-00060 - MEP Application - 10/2/2003 PERMIT NO.A 0-6 0c b
DATE RECEIVED:
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENTRECEIVED
RESOURCE ORDINANCE (Chapter 17.01 MCC)
411 N.5TH Street/P.O. Box 279,Shelton, WA 98584
OCT 0 2 1003
ENVIRONMENTAL PERMIT APPLICATION E��R gg
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MASON ENVIRONMENTAL PERMIT CONDITIONAL USE El426 W'�fAlRk
The purpose of the 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 __oo
1. Owner: i Owne ddress: � •
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Site Address L City: i State: Zip. KSDr
City: ii2.. State zip: $S-'oZ gLien/Title Holder:
Phone:Daytime 31S aK oc D-'l t ql'I'DLZ Address:
Fire Di City: State: Zip:
Signature:
2. Parcel Number: a3 _-° - QCO 0 Legal description:
L ecow y4 acres
Parcel Size: :--
3. Directions to Site: &yvi 44w . 3 Y n le1-P " 'CJ' f m L 14 UD
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4. State what sections require a permit: In-Holding Lands, Chapter 17.01.062 ❑
Long-Term Commercial Forest, Chapter 17.10.060 ❑ Wetlands, Chapter 17.01.070 ❑
Mineral Resource Lands, Chapter 17.01.066 ❑ Frequently Flooded Areas, Chapter 17.01,090 ❑
Aquifer Recharge Areas, Chapter 17.01.080 ❑ Landslide Hazard Areas, Chapter 17.01.100 X
Erosion Hazard Areas, Chapter 17.01.104 ❑ Seismic Hazard Areas, Chapter 17.01.102 ❑
Fish and Wildlife Habitat Conservation Areas, Chapter 17.01.110 ❑
5. n
Identify current use of property with existing improvements: Peo6(emer)+1
6. Identify and describe the proposed project, including the type of materials to be used,construction methods,principle
dimensions and other ertinent Innation(Attach additional sheets if needed):p ,
2
7 Any water on or adjacent to property: Saltwater ❑ Lake ❑ River ❑ Pond ❑ Wetland ❑ Seasonal Runoff ❑
Other
8. Will there be an alteration of a wetland and/or wetland vegetation area? Yes ❑ No
9. If septic is located on project site,include records. h..�ff^^
Connect to septic? El Community Septic? Public Water Supply? ❑ Well? El �� .tt Id t htQ �►t-U� lP
10. v
Type of Job: New 34 Add ❑ Alt ❑ Repair ❑ Demolition ❑ Other
This permit is granted pursuant to the 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 to this project,but
not inconsistent with the Resource Ordinance.The permit may be rescinded pursuant to the event the perniittee fails to comply
with the conditions of this ordinance.
MASON ENVIRONMENTAL PERMIT: $500.00/$300.00(with another permit)
MASON CONDITIONAL USE ENVIR.PERMIT: $1,2000.00
MASON RESOURCE ORDINANCE VARIANCE: $1,200,00 REVISED: 03-12-03
HEARINGS EXAMINER: $200.00 I:\PLANNING\R&GPAC\ENVIRONMENTAL PERMIT APPLICATION
Show the following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Water Lines Driveways
Drainage Plans Shorelines
Septic System Topography Indicate Directional by(N,S,E,W,etc.)
Proposed Improvements Easements In relation to plot plan
Name if Flanking Street 11
APPLICANT TO DRAW SITE PLAN BELOW:
APPLICANT TO DRAW TOPOGRAPHY BELOW:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
COMMENTS
Planning.-
Environmental Health:
Building Plan Review:
Occupancy Group:
Fire Marshal:
Other:
Conditions: FEES
TOTAL FEES:
Accepted by: Date:
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E ISTI G EIGH ORRAIL R
T AIL R
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NORTH
SCALE 1"=20'
C.I. =2'
DATUM ASSUMED
THIS IS NOT A SURVEY
0do
0 10 20 30 40
220 210 200
Geotechnical Testing Laborator PROJECT NAME: =OW2312003GeotechnicalServices 10011BlombergStSW LOUDINSITE �1ht•20be1Olympia.wA W512 301 EAST LARSON BLVD.QA/QC Servkes Phone(360)7544612 PARCEL 1233051p0080 Testing Servkes Fax.(360)7544848
FIGURE 2