HomeMy WebLinkAboutGRD92-0017 - GRD Letters / Memos - 8/18/1992 MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton,Washington 98584
(206)427-9670
BUILDING PARKS& RECREATION FAIR/CONVENTION CENTER ADMINISTRATION
August 18 , 1992
Jerry Raymond Land Modification Permit Application
E. 880$ Spencer Lake Road
Shelton, Washington
Owner is removing gravel from site for road project . Exempt from
Chapter 70, 1985 UBC. Section 7002 , #1 & #8 . Any additional
volumes or areas excavated will require Building Department review
for determination of further exemption. Mining activities over
three acres will require DNR mining permit, and review by the Mason
County Building Department and Planning Department .
4 Y �
Mike Byrne, Building Official
MASON COUNTY
--ZZ- LAND MODIFICATION PERMIT
(-;� Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427 -9670/1-800-562-5628
PLEASE PRINT
#1 Owner �� �2Pone# - l�J
Site Address i ty ` Sty Zip
Owner Address - Ci
Describe Work f=
#2 Contractor Name Contractor Reg#
Address Expiration date
City St Zip Phone
#3 Engineer's Name Phone#
Address City St Zip_
#4 Parcel No.
Legal Description_ SwS
#5 Number of cubic yards to be excavated: Ova
Number of cubic yards to be filled:
Number of cubic yards to be graded:
#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?
Does fill contain potentially hazardous materials?
Yes No �
#7 Will excavated materials be taken off site? Yes No
If Yes: Where cCi1.l excavated mate is.�s be ?
#8 Briefly describe existing terrain, vegetation, and improvements on
subject site?
#9 Has a soils report been completed on the subject site?
If yes, include copy with application.
#10 Does the subject site contain any of the following features?
River Lake Wetlands Sal twa ter
Slope greater than 15: Soft..compressible soils
Seasonal Runoff None
#11 Will the proposed land surface modification change the points
where storm water or groundwater enters or exits the site?
#12 Will the proposed land surface modification change the qua *'ty,
quanti ty, or veloci ty of storm wa ter/groundwa ter?
J
#13 Is the subject site within 200 feet of a designated shoreline?
#14 Whaff =thods, if any, will be utilized to minimize erosion and
possible sedimentation into nearby waters?
Ja G=
#15 Will this land modification result in the redirection of any surface
water runoff onto adjacent properties? 1
#16 WillrsfrFface or subsurface runoff be collected or controlled by
interceptors, curtain drains, or other water collection ev;ces
once this land modification has been completed?
#17 Will the land be replanted upon completion?
If yes, with what types of plants?
#18 What are the lengths and .heights of slopes currently existing on
the site? _ti ;znf� \ " ' ;j
#19 Will this modification result in slopes steeper than those currently
on the site? If so, how steep?
�� s* ISIT
1C,•�J•�e'.r
Show following on the site plan Directions to job site
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street
Name of Fronting Street
I
Scale:
Date:
f
VSy�� N�nA
i
OrisE 3'II3oda 7,Havuoodoz mvua oL ,I.NvoI'Iddrd
►nvw�n�yyl 1 : Rum
—aNi-i I-az-,-4j (7 a�V
r _..►-�? O� 2 ct�1t
7 %
M0792 NV7d SITS MWWn ().T. .T.KTlrM7rT,7,TW
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
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAW RCW 18.27 , AND AM AWARE IN THE STATE OF WASHINGTON AND I AM AWARE OF THE
OF THE MASON GOUNTY ORDINANCE REQUIREMENTS FOR WHICH ORDINANCE REQUIREMENTS REGULATING THE WORK FOR WHICH
THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT. DEPARTMENT.
X OWNER X BY
DATE DATE
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
FOR OFFICIAL USE ONLY: -Accepted by: Date:
DEPAR AL REVIEW
FOR OFFICE USE ONLY
T
Approved Cond Hold
Approval
Planning:
Environmental Health:
Building Plan Review:
�' � X..l it i L.it � kw)
Fire Marshall:
Other: