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HomeMy WebLinkAboutMIS99-00555 Remove Underground Storage Tanks - MIS Permit / Conditions - 9/2/1999 MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 M I S C E L L A N E O U S PERM I T FOR INSPECTIONS CALL 427-9670 MIS99-0555 PARCEL :41924OOOOOI0 PLAT : DIV : BLK : LOT : JOB ADDRESS : 780 W STATE ROUTE 108 SHELTON APPLICANT : SKOOKUM LUMBER CO 360-352-7633 OWNER : SKOOKUM LUMBER CO 360-352-7633 LEGAL : TR 1 OF SECTION N OF R.R.RII PROJECT DESCRIPTION : REMOVAL OF TWO UNDERGROUND STORAGE TANKS DIESEL AND GAS PROJECT LOCATION : 3/4 MO WEST ON HWY 108 FROM HWY 101 TURN RIGHT AT ROAD WITH SKOOKUM LBR CO SING . PROJECT NOTES : TYPE AMOUNT BY DATE RECEIPT PLCK $ 84 .00 KW 09/02/99 51439 TOTAL : 84 .00 OWNER A AGENT DATE MIS—PRMT, rev: 04/01192 COMPLIANCE TO ATTACHED CONDITIONS IS REQUIRED MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 P E R M I T C O N D I T I O N S Case No . : MIS99-0555 For : SKOOKUM LUMBER CO Page : 1 1 ) 1 . PROVIDE COPY OF SITE ASSESSMENT REPORT AND WORK PLAN THAT INDICATES DISPOSAL OF RINSE WATER FROM THE TANKS AND FINAL DISPOSAL OF TANKS . 2 . A COUNTY SITE INSPECTION IS NOT REQUIRED . X 2 ) Water quality is not being degraded to the detriment of the aquatic environment as a result of this project . X 3 ) All upland areas disturbed or newly created by construction activities shall be seeded , vegetated or given some other equivalent type of protection against erosion . PERMIT NO.: MIS MASON COUNTY MISCELLANEOUS PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner ���� ��rn IL LAyyi b1 -�. Contractor Name �t Mailing Address -g!;6 Mailing Address City State ,Zip Code City e, State Zip Code Phone 7 ."tither Ph.(�X.a) Ham-glil, Ph.( Other Ph.( %A70> - Lien/Title Holder Contractor Reg. # W-!0!59 I -A 1 s2l %74, Address Expirations/_ C� PARCEL INFORMATION-12 digit Tax Parcel No. AH --1 ZL} / / 00© I p Fire District Legal Description Site Address(include street name and city O opt Directions to site: n ✓'t I C— r�-ate Will timber be cut and sold in parcel preparation? (Yes/No) Mo Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other_ )�Use of Building Describe proposed construction -Ve4#►-e,4.- 1 (f2-) L.A^g" ✓l.A o e ✓� ,r( • SHORELINE PROJECTS New Replacement Repair Expansion Bulkhead Material (concrete, rock, wood, etc.) Length Height A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF PERMIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a the Contractor Registration Law RCW 18.27 and am aware of the contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work ordinance requirements regulating the work for which this permit is issued will be done in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall first pproval. be made without first obtaining approval. X Date 'A X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by�IEl Da ittal Amount Due -)t e?— Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department M re✓"GLO Occ Grp Type of Const. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee Other UFC Plan Review Fee Other Violation Fee Pre-Paid at Submittal ( ) -XX :>':: TOTAL FEE S I