HomeMy WebLinkAboutMEP- Fill Site - MEP Application - 1/30/1999 PERMIT NO.:
DATE RECEIVED:
MASON COUNTY �eCe0tii jt`'Lt��a
DEPARTMENT OF COMMUNITY DEVELOPMENT
INTERIM RESOURCE ORDINANCE (Chapter 17.01 MCC)
411 N. 5TH Street/P.O. Box 578,Shelton,Wa 98584
ENVIRONMENTAL PERMIT APPLICATION
MASON ENVIRONMENTAL PERMIT ❑ CONDITIONAL USE ❑ VARIANCE ❑
The purpose of the Interim 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 FEE:$110,00
1. Owner: KO.VA0. Owner Mailing Address: N. 3 95 9 +}►_
Site Address: N. 35 613 ►o► City: State: VIJA Zip: 9» 55
City: LtWwooAp State: O '-Zip: 98655 Lien/Title Holder: ti'f)•,e
Phone:(%%) g77--5$90 Fire District# Address: /✓.A-.
City: AAA—. State:- A61I- . Zip:
2. Parcel Number: s zt Z7 _ oo _ OLt oo Legal description: M Vz S 12 S 2 7 "t Z`t of R 3w uiM
s15 Zo es s tktV.
Parcel Size: 32.a A,Ye 5 + l t o
3. Directions to Site: \ �{
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SR.-ln/ �4 �oKi MP- 321 �ww , xw.a O �c, f G�7ch
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4. State what sections required a permit:
Long-Term Commercial Forest, Chapter 17.10.060; Inholding Lands, Chapter 17.01.062;
Mineral Resource Lands , Chapter 17.01.066; Wetlands, 17.01.070; Critical Aquifer Recharge,
Chapter 17.01.080; Aquatic Management Areas, Chapter 17.01.110; Frequently Flooded Areas,
Chapter 17.01.090; Landslide Hazard Areas, 17.01.100; Seismic Hazard Areas, Chapter 17.01.102;
Erosion Hazard Areas, 17.01.104.
5. Identify current use of property with existing improvements:
er►. �rw� o r-orcl�, 1lowevev no C MarccWj yW��t 1lwc6er ehL31 a�.i�t,
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6. Identify and describe the proposed project, including the type of materials to be used, construction methods,
principal dimensions`and other pertinent information (\Attach additional sheets iff needed)* I
\S &J S `ro . YOVLJ t rle-CLV,iof S. r a."d S. L t, V'(%
rrr� UYr Q� lof es oca MP- 2Z M 326 . �e
11 aV0.\ e t 4.wf LjeJA oLts. like Xc a va.1 r Fm, r�
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7. Any water or ad'ace to property: Saltwater Lake Mo River Pond/�o Wetland All)
Seasonal unoff b Other ,{/YQ
A 1+1.�<<"�,�,�. lL-:►I6 a.1.y a-wa.y
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8. Will there be an alteration of a wetland and/or wetland vegetation area? Yes No A110
9. If septic is located on project site, include records.
Connect to septic? It' Community Septic? Public Water Supply? A/+ Well? IV&
10. Type of Job: New Add Alt Repair Demolition Other �►<< S►,<., L-;►tL. `,&,KA
This permit is granted pursuant to the Interim Resource Ordinance(Chapter 17.01 MCC)al nothing in this peml'it 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 Interim Resource Ordinance. The permit may be rescinded pursuant to the
event the permittee fails to comply with the conditions of this ordinance.
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Show the following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Stucture Setbacks Driveways
Water Lines Shorelines
Drainage Plans Topography
Septic System Wells Indicate Directional by(N,S,E,W,etc.)
Proposed Improvements Easements in relation to plot plan
Name of Flanking Street
APPLICANT TO DRAW SITE PLAN BELOW
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APPLICANT TO DRAW TOPOGRAPH BELOW:
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DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Planning:
Environmental Health:
I
Building Plan Review:
Occupancy Grojp:
Fire Marshal:
Other:
Conditions: FEES
l TOTAL FEES:
Accepted by: gate: