HomeMy WebLinkAboutMEP2004-00003 ATF Approval of Grading - MEP Permit / Conditions - 1/21/2004 m�P�� 'c
' PERMIT NO.: ��
DATE RECEIVED:
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT RECEIVED
RESOURCE ORDINANCE (Chapter 17.01 MCC)
411 N.5TH Street/P.O. Box 279, Shelton, WA 98584 ►JAN 21 2004
ENVIRONMENTAL PERMIT APPLICATION 426 W! CEDAR STR
R T F MASON ENVIRONMENTAL PERMIT CONDITIONAL USE ❑ VARIANCE ❑
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: 1`-� :� �t.�, �. i.�t�,Luz 1i✓ Owner,]�1 ailing Address:_ if6
Site Address: t t 9 V e Qd - City: 15V7--1,01 e.✓'�e r x State: Wen- Zip:_!
City: State Zip: Lien/Title Holder:
Phone:Daytime(3k ) d 17 R-_ � Address:
Fire District#: City: State: Zip:
Signature: -2. Parcel Number: 'j 2, "_(DC)b D O Legal description:
C C_
Parcel Size:
3. DirectiorLs to Site: r d / ,e
flit ct� A.�:r �.✓% Gr _ P— r
_e aSfi - o�
to rc g r
4. tate what sections require a permCA
it: - In-Holding Lands, Chapter 17.01.062 El
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 X
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 cu-icent use of property with existing improvements: r4P_ r-2. fit,' 1.1 t`
6. Identify and describe the proposed project, including the type of materials to be used, onstruction methods,principle
dimensions and other pertinent information Attach additional sheets if needed): W C,t' .� V -y—
7.
Any water on or adjacent to property: Saltwater ❑ Lake ❑ River ❑ Pond ❑ Wetland ❑ Seasonal Runoff ❑
Other
8. Will there be an alteration of a wetland and/or welasnd veRetot;rm ar.�a9 VP• !-1
9. If septic is located on project site, include records.
Connect to septic? ❑ Community Septic? ❑ Public Water Supply? ❑ Well? ❑
10.
Type of Job: New ❑ Add X 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.
MASON ENVIRONMENTAL PERMIT: $500.00/$300.00(with another permit)
MASON CONDITIONAL USE ENVIR.PERMIT: $1,2000.00
MASON RESOURCE ORDINANCE VARIANCE: $1,200,00 REVISED: 03-12-03
HEARINGS EXAMINER: $200.00 I:\PLANNING\R&GPAC\ENVIRONMENTAL PERMIT APPLICATION
Show the following on the site plan
a
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 SITE PLAN BELOW:
APPLICANT TO DRAW TOPOGRAPHY BELOW:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
COMMENTS
Planning:
Environmental Health:
Building Plan Review:
Occupancy Group:
Fire Marshal:
Other:
LI
Condit;,, s:_ FEES
TOTAL FEES:
Accepted by: Date:
SF"G
` THE SHORELINE PEMIT PROCESS
Page 5
Publication cost is the responsibility of the applicant. Final permit processing will not
occur until advertising fees have been paid to the newspaper by the applicant. The
Shelton-Mason County Journal will bill the applicant directly.
I /WE understand that I /WE must sign and date the attached acknowledgment
indicating and that I / WE understand that is MY / OUR responsibility. I / WE must
submit the signed page as part of application in order for it to be considered as
complete.
DATE
OWNER
APPLICANT
i HE SHORELINE PERMIT PROCESS
Page 6
LIST OF ADJACENT PROPERTY OWNERS
WITHIN 300 FEET OF YOUR PROPERTY BOUNDARIES
FOR CONDITIONAL USE AND VARIANCE
Addresses are to be obtained from the Mason County Assessor's Office, Bldg. 1, Second Floor,
Revised 1/03
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