HomeMy WebLinkAboutMEP2015-00017 - MEP Application - 5/20/2015 ❑ MASON ENVIRONMENTAL PERMIT($630 or S380 w/other permit) Mason County Permit Center Use:
❑ CONDITIONAL USE($1520) MEPOe))5 -
❑ HABITAT MANAGEMENT PLAN REVIEW ($445)
Date Rcvd 5'Zo —2-0 15
MASON COUNTY RECEIVED
DEPARTMENT OF COMMUNITY DEVELOPMENT MAY 2 0 2015
Mason County Resource Ordinance(Chapter 17.01 MCC) 426 W. rFDAR S1
ENVIRONMENTAL PERMIT APPLICATION
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
1. PROPERTY OWNER
Name: n ` i 1 oyn �. ('/k�
Mailing Address: V ► v
Work Phone: 253 ` /� Email Address: 1.- �
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Home/Cell Phone: Fax#: 66 rn
If an agent is acting for the property owner during the permit process, complete 92.
2. AUTHORIZED AGENT
Name:
Mailing Address:
Work Phone: Email Address:
Home/Cell Phone: Fax#
3. PROJECT SITE
Site Address:
Parcel #: - - Legal Description:
Directions to Site:
Attach a site plan showing the following: Lot Dim ions,Flood Zones, Existing Structures,Fences,
Water Lines,Driveways,Drainage Plans,Shorelines,Septic System,Topography, Proposed
Improvements,Easements,North Arrow, and Scale. Also draw a separate topography diagram.
Following minimum buffer requirements would impact the existing EVA
fire access to the back of the school and reduce area for school recess.
new proposed portables. Part of this project will be to remove an existing
portable that is completely within the buffer. Areas within
the buffer are
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4. State which section requires permit:
❑ Long Term Commercial Forest,Chapter 17.10.060 ❑ Frequently Flooded Areas,Chapter 17.01.090
❑ Mineral Resource Lands,Chapter 17.01.066 ❑ Landslide Hazard Area,Chapter 17.01.100
❑ Aquifer Recharge Area,Chapter 17.01.080 ❑ Seismic Hazard Areas,Chapter 17.01.102
❑ Erosion Hazard Area,Chapter 17.01.104 Fish&Wildlife Habitat Conservation Areas,Chapter
❑ In-Holding Lands,Chapter 17.01.062 17.01.110
❑ Wetlands,Chapter 17.01.070
5. Ideiintt�ify current use of the property 'with existing improvements:
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6. Identify and describe the proposed project, including the type of materials to be used,construction methods,
principle dimensions,and other pertinent information(attach additional sheets,if needed):
4 124 1 4l
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7. Describe why the action requiring this permit cannot�e avoided.
8. Will there be an alteration of a wetland and/or wetland vegetation area(circle one)? Yes No
9. Identify any surface water on or adjacent to property (circle one):
Saltwater Lake Stream Pond Wetland Drainage Ditch
10. Identify existing septic/sewer connection(circle one): If septic is located on project site, include records.
Connected to Septic Connected to Community Septic ,(, �Q ►i
11. Identify existing water supply(circle one): ublic Water Supply Well
11. Type of Job(circle one):New Add Alteration Repair Demolition Other '— a -
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