HomeMy WebLinkAboutMEP2008-00018 - MEP Application - 7/7/2008 PERMIT NO.:
DATE RECEIVED:
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE ORDINANCE (Chapter 17.01 MCC)
411 N.5TH Street/ P.O. Box 279, Shelton, WA 98584
ENVIRONMENTAL PERMIT APPLICATION
MASON ENVIRONMENTAL PERMIT❑ CONDITIONAL USE ❑
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
Owner: ` Owner Mailing Address:
Site Add r ss, ��"��t,
/F/� State
City: Stateu-xZip Lien/Title Holder��
Phone:Daytime(2___(�26 1_1 !
Address:
Fire District#:_
City: State: Zip:
Signature:
2. Parcel Number: Z 2l _22 00 O Legal description:
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Parcel Size:
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3. Directions to site: 2Z 9-7
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State what sections require a permit: In-Holding Lands, Chapter 17.01.062 ❑
4. 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 ❑
Erosion Hazard Areas, Chapter 17.01.104 ❑ Seismic Hazard Areas, Chapter 17.01.102 ❑
Fish and Wildlife Habitat Conservation Areas,Chapter 17.01.110 0
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5.
Identify current use of property with existing improvements:
/ S / R-!-x-,
6.
Identify and describe the proposed project,including the type of materials to be used,construction methods,principle
dimensions and o er pertinent information Attach a itional heets if
needed): Tl/f /s x 'Ya 0 C'P ca�?cam �nu 7:2
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7.
Will there be an alteration of a wetland and/or wetland vegetation area? Yes ❑ No
8. Any water on or adjacent to property:
Saltwater ❑ Lake ❑ River Pond ❑ Wetland ❑ Seasonal Runoff 0
Other
9. If septic is located on project site, include records.
Connect to septic? ❑ Community Septic? ❑ Public Water Supply? 0 Well? 0
10. �/
Type of Job: New ❑ Add 0 Alt 0 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 permittee fails to comply with the conditions of this ordinance.
MASON ENVIRONMENTAL PERMIT: $560.00/$335.00(with another permit)
MASON CONDITIONAL USE ENVIR.PERMIT: $1,350.00
HABITAT MANAGEMENT PLAN: $395.00
]:\PLANNING\C&R\ENVIRONMENTAL REVISED 01-16-07
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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
APPLICANT TO DRAW SITE PLAN BELOW:
CG uvGCS
APPLICANT TO DRAW TOPOGRAPHY BELOW:
MASON COUNTY RESOURCE ORDINANCE July 2003
m' processing will no r nil
Publication cost is the responsibility of the applicant.-Final permit p ocess g t occur until
advertising fees have been paid to the newspaper by the applicant. The Shelton-Mason County Journal
will bill the applicant directly.
I /WE understand that I /WE must sign and date the attached acknowledgment indicating and that I /
WE understand that is MY/OUR responsibility. I /WE must submit the signed page as part of
application in order for it to be considered as complete.
DATE
OWNER
APPLICA
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MASON COUNTY RESOURCE ORDINANCE July 2003
LIST OF ADJACENT PROPERTY OWNERS
WITHIN 300 FEET OF YOUR PROPERTY BOUNDARIES
FOR CONDITIONAL USE AND VARIANCE
Addresses are to be obtained from the Mason County Assessor's Office, Bldg. 1, Second Floor.
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