HomeMy WebLinkAboutMEP2024-00034 - MEP Application - 12/23/2024 Mason County Permit Center Use:
MASON COUNTY MEP oaf 000
COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health Date Rcvd
615 W.Alder St.—Bldg.8,Shelton,Wa 98584
Phone:(360)427-9670 ext.352♦ Fax:(360)427-7798
MASON ENVIRONMENTAL PERMIT:$115
❑ MASON ENVIRONMENTAL PERMIT WITH HABITAT MANAGEMENT PLAN:$1500
❑ CONDMONAL USE: $2000
Mason County Resource Ordinance(Chapter 8.52 MCC)
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: David and Verity Dammann
Mailing Address: 401 N 12TH STREET SHELTON WA 98584
Work Phone: Email Address:
Home/Cell Phone: Fax#:
If an agent is actingfor the property owner during the perpnit process,complete#2.
2.AUTHORIZED AGENT
Name: Derek Johnson,Pinnacle Construction NW LLC
Mailing Address: 110 W K Street Suite C,Shelton WA 98584
Work Phone: 360-780-3890 Email Address: team@pinnaclepnw.com
Home/Cell Phone: Fax#
3.PROJECT SITE
Site Address: 480 W SIMPSON RD Shelton WA 98584
Parcel#: 520017700020 - Legal Description: TR 2 OF SURVEY 6/41
Directions to Site: 101-N West Shelton Matlock Road to West Hanks Lake Road to W Simpson Road
Attach a site plan showing the following: Lot Dimensions,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.
Rev.March 1,2018
4. State which section requires permit:
❑ Long Term Commercial Forest,Chapter 8.52.060 ❑ Frequently Flooded Areas,Chapter 8.52.130
❑ Mineral Resource Lands,Chapter 8.52.090 ❑ Geologically Hazardous Areas,Chapter 8.52.140
❑ Critical Aquifer Recharge Areas,Chapter 8.52.120 ❑ Seismic Hazard Areas, Chapter 8.52.150
❑ Erosion Hazard Area,Chapter 8.52.160 ❑ Fish&Wildlife Habitat Conservation Areas,Chapter
❑ In-Holding Lands,Chapter 8.52.070 8.52.170
® Wetlands,Chapter 8.52.110
5. Identify current use of the property with existing improvements:
Tthe property is predominatnley undeveloped forested parcel with a well,RV parking area and driveway for
recreational use.
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):
The project consists of a 28x56(1,568 sq R) 3-bedroom single-family residence and onsite septic with a
drainfield,utilizing the existing well and the existing driveway for ingress and egress.
7. Describe why the action requiring this permit cannot be avoided.
The applicant requires a house with typical appurtenances to allow year around living
8. Will there be an alteration of a wetland and/or wetland vegetation area(circle one)? Yes r7ol
9. Identify any surface water on or adjacent to property(circle one):
Saltwater Lake Stream Pond r7reMMM 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
11. Identify existing water supply(circle one): Public Water Supply Well
11. Type of Job(circle one):
New Add Alteration Repair Demolition Other-
Print Name Signature Date
Rev.March 1,2018
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