HomeMy WebLinkAboutJARPA - SHX Application - 1/1/2017 ----------------------------------------
AGENCY USE ONLY i
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WASHINGTON STATE W E yCo[�s ,
of En Inee[s ; Date received
Seattle District
Joint Aquatic Resources Permit
Application (JARPA) (help] Agency reference#:
' Tax Parcel#(s): ,
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Attachment A: '
For additional property owner(s) [hem TO BE COMPLETED BY APPLICANT[hel
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Project Name: Hood Canal Steelhead
Project:Juvenile Monitoring
Use this attachment only if you have more than one property owner. Location Name(if applicable):Tahuya Trap
Complete one attachment for each additional property owner Site
impacted by the project.
Signatures of property owners are not needed for repair or maintenance activities on existing rights-of-way or
easements.
Use black or blue ink to enter answers in whites aces below.
1. Name(Last, First, Middle)and Organization (if applicable)
Evans, Lonnie
2. Mailing Address(street or PO Box)
7426 NE 1551h St.
3. City, State, Zip
Kenmore, WA 98028
4. Phone (1) 5. Phone(2) 6. Fax 7. E-mail
Address or tax parcel number of property you own:
322237500160
Signature of Property Owner
I consent to the permitting agencies entering the property where the project is located to inspect the project
site or any work. These inspections shall occur at reasonable times and, if practical, with prior notice to the
landowner.
Printed Name to nn(e �J• Signature / I
If you require this document in another format,contact the Governor's Office for Regulatory Innovation and Assistance(ORIA)at
(800)917-0043. People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call
877 833-6341. ORIA publication number:ORIA-16-012 rev. 10/2016
JARPA Attachment A Rev. 1012016 Page 1 of 1
nui ,----------------------------------------
AGENCY USE ONLY
WASHINGTON STATE : Date received:
Joint Aquatic Resources Permit
Application (DARPA) hel
Agency reference#: ;
Tax Parcel#(s):
Attachment B:
For additional project location(s) [he, ------TOBE COMPLETED BY APPLICANT-Lhelp]-----
Project Name:Hood Canal Steelhead Project:
Use this attachment only if you have more than one project location. Juvenile Monitoring
Location Name(if applicable):Tahuya
Use a separate form for each additional location. River Trap Site
--------------------------------------
Use black or blue ink to enter answers in whites aces below.
1. Indicate the type of ownership of the property. (Check all that apply.) [neem
® Private
❑ Federal
❑ Publicly owned (state,county,city,special districts like schools,ports,etc.)
❑ Tribal
❑ Department of Natural Resources(DNR)—managed aquatic lands (Complete JARPA Attachment E)
2. Street Address (Cannot be a PO Box. If there is no address,provide other location information in 16) hel
2865 NE Tahuya River Rd.
3. City, State, Zip(If the project is not in a city or town,provide the name of the nearest city or town.) hel
Tahuya, Washington 98588 (Tahuya River trap site)
4. County h[ elpj
Mason
5. Provide the section, township, and range for the project location. [help]
'/4 Section Section Township Range
NE 1/4 23 22 N 03 W
6. Provide the latitude and longitude of the project location. hel
• Example:47.03922 N lat./-122.89142 W long(Use decimal degrees-NAD 83)
47.389370 N lat. /-123.020217 W long. (NAD 83)
7. List the tax parcel number(s)for the project location. [helgj
• The local county assessor's office can provide this information.
322237500160
JARPA Attachment B Rev.10/2016 Page 1 of 3
8. Contact information for all adjoining property owners. (if you need more space,use DARPA Attachment C.) [help]
Name Mailing Address Tax Parcel #(if known)
Lonnie Evans 7426 NE 15511 St. 322144400000 and
(adjoining to the north and Kenmore, WA 98028—� 322237500150
south)
Richard and Susan Brewer 1520 S 2"d St 322144390050
(adjoining to the west) Shelton, WA 98584
American Assoc. for the PO Box 312 322231200040
Furtherance of Community ---._.._.._._------.._.__......_..._._.......__... -_.._..--
(adjoining to the south) Tahuya, WA 98588
Rainier Evergreen Inc. 11221 Pacific Hwy SW 322237500040
(adjoining to the east) Tacoma, WA 98499
9. List all wetlands on or adjacent to the project location. Lhtlp]
10. List all waterbodies (other than wetlands) on or adjacent to the project location. hei
Tahuya River
11. Is any part of the project area within a 100-year flood plain? h[ elp]
® Yes ❑ No ❑ Don't know
12. Briefly describe the vegetation and habitat conditions on the property. h[ 1A
The property consists of undeveloped land with stream and riparian habitats containing conifer and deciduous
trees. An open field is adjacent to the riparian zone.
13. Describe how the property is currently used. [bpi]
Undeveloped land.
JARPA Attachment B Rev. 10/2016 Page 2 of 3
14. Describe how the adjacent properties are currently used. hel
Residential and forest land
15. Describe the structures (above and below ground) on the property, including their purpose(s). h[ eM
None
16. Provide driving directions from the closest highway to the project location, and attach a map. hel
From Belfair, take NE WA-300/N Shore Rd. Turn R onto NE Belfair Tahuya Rd. Turn L onto Tahuya River
Road. Turn L into 2865 NE Tahuya River Rd (Kirsten Rohde's property). Follow driveway to open field and
walk trail to trap site.
If you require this document in another format,contact the Governor's Office for Regulatory Innovation and Assistance(ORIA)at
(800)917-0043. People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call
877 833-6341. ORIA publication number:ORIA-16-013 rev. 10/2016
JARPA Attachment B Rev.10/2016 Page 3 of 3