HomeMy WebLinkAboutGRD2021-00013 Cancelled - GRD Application - 9/10/2021 Zi C
i�eQ ~rr MASON COUNTY PERMIT NO I` w
DEPARTMENT OF COMMUNITY DEVELOPMENT RECEIVE D
BUILDING. PLANNING• FIRE MARSHAL
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
Mason County Bldg. 8, (360)275-4467 Belfair A5
IA54 615 W.Alder Street,Shelton,WA 98584 (360)482-5269 Elma 35J O 2021
LAND MODIFICATION PERMIT (Grading Permi�1 5 W. 'alder Street
OWNER INFORMATION: c�_l CONTRACTOR INFORMATION:
NAME: Rick Buechel ' �r am) NAME:
MAILING ADDRESS: Po Box 249 MAILING ADDRESS:
CITY:Union STATE:WA ZIP:98592 CITY: STATE: ZIP:
PHONE:360-898-2481 CELL:360-490-7000 PHONE: ELL:
EMAIL:rickb@hoodcanal.net EMAIL :
L&I REG EXP.
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER)3223 4 0013 FIRE DISTRICT 6
LEGAL DESCRIPTION(ABBREVIATED):LOT$ OF SEN3059 AF#1948722
SITE ADDRESS 750 E Dalby Rd CITY Union
DIRECTIONS TO SITE ADDRESS From Shelton take M avv tp4Jnion. Take right on Da1bV Rd. Pro ert
is on the left
IS PROPERTY WITHIN 200 FT:
SALTWATER❑ LAKE ❑ RIVER/CREEK X WOADYWETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 3WE PROJECT-GREATER THAN 14% YES X❑ NO ❑WILL TIMBER BE CUT AND SOLD IN PAARATION ? YES ❑ NO x❑
TYPE OF JOB: EXCAVATION X ING ❑ GRADING X❑ CUTTING ❑X OTHER ❑
TOTAL SIZE OF PAR EL 5. ACRES/SQ FT SIZE OF AREA TO BE EFFECTED 1 ACRES/SQ FT
ESTIMATED AMOUN Y OF CUBI S 3000
DOES THE SITE HAVE S OPES 14- OR GREATER YES❑X NO[]
DESCRIBE SCOPE OF WO Exc ation and cirading of hillside
WILL FILL BE BROUGHT ON SITE? IF YES,SITE ADDRESS:
WILL EXCAVATED MATERIAL BE TAKEN OFF SITE? IF YES,SITE ADDRESS:
DOES FILL CONTAIN POTENTIAL HAZARDOUS MATERIALS? YES ❑ NO 0'
HAS A SOILS REPORT BEEN COMPLETED ON SITE?IF YES,INCLUDE A COPY. YES NO❑
WILL PROPSAL RESULT IN REDIRECTION OF ANY SURFACE WWATER RUNOFF? YES ❑ NO Q
WILL WORK ALTER WHERE STORMWATER OF GROUND WATER ENTERS OR EXISTS THE SITE? YES ❑ NO Q
WILL QUALITY,QUANTITY OR VELOCITY OF STORM/GROUND WATER BE ALTERED? YES ❑ NOR
WILL THE RUNOFF BE COLLETED/CONTROLLED BY INTERCEPTORS,CURTAIN DRAINS OR OTHER DEVICES? YES ❑ NO e
WILL THE LAND BE REPLANTED UPON COMPLETION? YES ❑ NO Q'
WILL THE PROPOSAL RESULT IN SLOPES STEEPER THAN THOSE CURRENTLY ON SITE? YES B NO ❑
IS THE SITE WITHIN 200 FT OF A DESIGNATED SHORELINE OR A WETLAND? YES q NO❑
OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or contractor. I further
declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary
parties,including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for
review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF
IINSPECTI INACTIV OF THIS P ERMIT APPLICATION OF 180 DAYS WILL INVi
, LIDATE THE APPLICATION.
•
17-1
Sigp�ure of Applic t to
X /�1 be- I U C C,h� OWNER REPRESENTATIVE/CONTRACTOR
-print Name (CIRCLE TO INDICATE)
ARCTOS
9AERIAL
oo� Environmental onsulting I Drone Imager-
0 Box 2466
Shelton, WA 98584
(425) 344-9315
arctosaerial@gmail.com
www.arctosaerial.com
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Map created by: Rob Nagel
1C� mii May 29th, 2021
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Existing Bridge/ .
Replacement Location N
±611 ft 0 40 80 120 160 ft
E DALBYRD
Scale: 1 " = 60'