HomeMy WebLinkAboutMEP2005-00006 Dock - MEP Application - 1/20/2005 w
PERMIT NO.: i0600
MASON COUNTY
DATE RECEIVED:
DEPARTMENT OF COMMUNITY DEVELOPMENT RECEIVED
RESOURCE ORDINANCE (Chapter 17.01 MCC)
411 N.5TH Street/P.O. Box 279, Shelton, WA 98584
ENVIRONMENTAL PERMIT APPLICATION JAfV 2 1005 ,
MASON ENVIRONMENTAL PERMIT 4 CONDITIONAL USE ❑ aE VIAfS�E �E
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
Owner: 4A flV 0 Owner Mailing ddress
Site Address: �k� City:,SV� Q State: Zip: 1
City: I hilq t. State ip: Lien/Title Holder:
Phone:Daytime a'75-�O51C Address:
Fire District#: City: State: Zip:
Signature:
2' Parcel Number: 2 23 3 Q-_ p _ p0 Legal description: R(V e�-t 47iP ']_ /0�> _
Parcel Size: r
3. Dir ctions to Site: 0 rn �o�j� � e_l&� /- 0."
j Ue m e o r to v
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4. State what sections require a permit: In-Holding Lands, Chapter 17.01.062 ❑
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
5.
Identify current use of property v,$h existing improvements:
6. II
Identify and describe the proposed project,including the type of materials to be used,construction methods,pri ipI
Piensions d other pertinent informati (A ch additional ets if ne ded
7.
Any water on or adjacent to property: Saltwater ❑ Lake River ❑ Pond ❑ Wetland ❑ Seasonal Runoff ❑
Other
8.
Will there bean alteration of a wetland and/or wetland vegetation area? Yes ❑ No
9' If septic is located on project site, include records.
Connect to septic? ❑ Community Septic? ❑ Public Water Supply? ❑ Well? ❑
10.
Type of Job: New t Add ❑ Alt ❑ 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not inconsistent with the Resource Ordinance.The permit may be rescinded pursuant to the event the permittee fails to comply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.
510 424
MASON ENVIRONMENTAL PERMIT: $599.9A/ �th another permit)
MASON CONDITIONAL USE ENVIR.PERMIT: /;k015
MASON RESOURCE ORDINANCE VARIANCE: $4,290, 0 1;L�1•• REVISED: 03-12-03
HEARINGS EXAMINER: 62AO. 0 1 I:\PLANNING\R&GPAC\ENVIRONMENTAL PERMIT APPLICATION
Show the following on the site plan
� II
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 SIT LAN BEL W:
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APPLICANT TO DRAW TOPOGRAPHY BELOW:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
COMMENTS
Planning:
Environmental Health:
Building Plan Review:
Occupancy Group:
Fire Marshal:
Other:
Conditions: FEES
TOTAL FEES:
Accepted by: Date: