The URL can be used to link to this page

Home My WebLink AboutSHX2002-00012 JARPA - SHX Application - 12/10/2001 r. 'g, .. .... A:.i::.r:orrrr..........:............. .... ...... w JARPA FORM I I �� pTF-� N (fo(use in Washington State) jam` +, PLEASE TYPE OR PRINT IN BLUE OR BLACK INK ,?•mot u..+°y Based on the preceding checldist, I am sending copies of this application to the following: (check all that apply) Local Government for shoreline: ❑Substantial Development ❑ Conditional Use ❑ Variance ❑ Exemption,or,if applicable ❑ Floodplain Management ❑Critical Areas Ordinance Washington Department of Fish and Wildlife for HPA ❑ Washington Department of Ecology for: ❑Approval to Allow Temporary Exceedance of Water Quality Standards ❑401 Water Quality Certification Nationwide Permits ❑ Washington Department of Natural Resources for:❑Aquatic Resources Use Authorization Notification ❑ Corps Engineers for:❑ Section 404 ❑Section 10 permit ❑ Coast Guard for: ❑ Section 9 Bridge Permit SECTION A -Use for all permits covered by this application. Be sure to also complete Section C(Signature Block)for all permit applications. 1.APPLICANT M I L (1C�C e S MAILING ADDRESS �� n L �� . � C2 1 D� WORK PHONE HOL HONE FAX# ZS $ 5l - ODE Kan agent Is acting for the applicant during the permit process,complete#2. 2 AlfT�fORIZED AGENT /h/ e. " l,-�v V"' !N ADORE O 10"E�—g �' \� Val C I WORK PHONE HOME PHONE FAX# � ) 2"7s- So aG J.RELATIONSHIP OF APPLICANT TO PROPERTY: OWNER ❑PURCHASER ❑LESSEE ❑OTHER: 4,NAME,ADDRESS,AND PHONE NUMBER OF PROPERTY OWNER(S),IF OTHER THAN APPLICANT: S.LOCATION(STREET ADDRESS,INCLUDING CITY,COUNTY AND ZIP CODE,WHERE PROPOSED ACTIVITY EXISTS OR WILL OCCUR) '2-7 31 -Oa- vLLAA_) w►4. of S4l0 , WATERBOOY TRIBUTARY OF 114 SECTION TOWNSHIP RANGE GOVERNMENT LOT SHORELINE DESIGNATION 33 2 ZONING DESIGNATION Z2 TAX PARCEL NO DNR STREAM TYPE,IF KNOWN Z-2. SZ Cd O 3 �-/L40 z 1 i I App G&tj*n Page 1 of 4 � I DESCRIBETHIS USE OF PROPERTY ,INDI(JATE MHO pD��(1LTURES E70 IM ON THE PROPERTY. F ANY PORTION OF THE PROPOSED AC71VrtY IS ALREADY CSL�c�o�}-toles ��. . Z 7W ON Is THE PROPERTY AGRICULTURAL LAND?❑YES f]NO 7a. DESCRIBE THE PROPOSED WORK COMPLETE ARE YOU A USDA PROGRAM PARTK2PA►/7 0 YES PLANS AND SPECIFICATIONS SHOULD BE PROVIDED FOR ALL WORK WATERWARD OF THE ORDINARY HIGH WATER 1 V 12 v S , d MARK OR 7b.DESCRIBE THE PURPOSE OF THE PROPOSED WORK 4o, ) 7c. DESCRIBE THE POTENTIAL IMPACTS TO CHARACTERISTIC USES OF THE WATER BODY. THESE USES MAY INCLUDE FISH AND AQUATIC LIFE SUPPLY,RECREATION,and AESTHETICS. IDENTIFY PROPOSED ACTIONS AVOID,MINIMIZE,AND MITIGATE DETRIMENTAL IMPACTS,AND PROVIDE PROPER PROTECTION jQ ,r, WATER QUALITY,WATER PREPARATION OF DRAWINGS: SEE APPENDIX A-SAMPLE DRAWINGS AND CHECKLIST FOR COMPLETING THE DRAWINGS. ONE SET OF ORIGINAL OR GOOD QUAL/TY P"RODOCIBLE DRAWINGS AfW BEATTACHED. NOTE APPLICANTS ARE ENCOURAGED TO SUBMIT PHOTOGRAPHS OF THE PROJECT SITE,BUT THESE DO NOT SUBSTITUTE FOR DRAWINGS. THE CORPS OF ENGINEERS AND COAST GUARD REQUIRE DRAW/NGS ON 8-f12 X f f INCH SHEETS. LARGER DRAWINGS MAYBE REQUIRED NOT SUBTHESTITUTE AGENCIES S.WILL THE PROJECT BE CONSTRUCTED IN STAGES? PROPOSED STARTING DATE: �b.I S' — (O—, —Q'Z .% ❑YES ❑NO ESTIMATED DURATION OF ACTIVITY: I W,2� 0.CHECK IF ANY STRUCTURES WILL BE PLACED: 13 WATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE FOR FRESH OR TIDAL WATERS;AND/OR O WATERWARD OF THE MEAN HIGH WATER LINE IN TIDAL WATERS 10.WILL FILL MATERIAL(ROCK FILL,BULKHEAD,PILINGS OR OTHER MATERIAL713EPLACED. r�O WATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE FOR FRESHS? v 0 WATERWARD OF THE MEAN HIGHER HIGH WATER FOR TIDAL WATERS? IF YES,VOLUME(CUBIC YARDS) /AREA (ACRES IF YES,VOLUME(CUBIC YARDS) /AREA (ACRES) 11.WILL MATERIAL BE PLACED IN WETLANDS? F YES: ❑YES 0 A.IMPACTED AREA IN ACRES: B.HAS A DELINEATION BEEN COMPLETED? IF YES,PLEASE SUBMIT WITH APPLICATION. C.HAS A WETLAND REPORT BEEN PREPARED?F YES, ❑YES RANO PLEASE SUBMIT WITH APPLICATION. O.TYPE AND COMPOSITION OF FILL MATERIAL(E.G..SAND,ETC.): ❑YES V440 E.MATERIAL SOURCE: F.LIST ALL SOIL SERIES(TYPE OF SOIL)LOCATED AT THE PROJECT OBTAINED FROM THE NATURAL RESOURCESCONSERVATION SERVICE SITE OBTAINED F THEY ARE ON THE COUNTY'S LIST OF HYDRIC SOILS. SOILS INFORMATION CAN BE 12.WlL PROPOSED ACTIVITY CAUSE FLOODING OR DRAINING OF WETLANDS? ❑YES OZD Application Pape 2 of 4 �F YFS,PAPACTED AREA I` _ACRES , WIL EXCAVATION OR DREDGING BE REQUIRED IN WATER OR WETLANDS? ❑YW❑NO F YES: A VIDLIJME_(CUBIC YARDS)tAREA_(ACRES) B.COMPOSITION OF MATERIAL TO BE REMOVED. C.DISPOSAL SITE FOR EXCAVATED MATERIAL: D.METHOD OF DREDGING: 14.LIST OTHER APPLICATIONS,APPROVALS,OR CERTIFICATIONS FROM OTHER FEDERAL,STATE OR LOCAL AGENCIES FOR ANY STRUCTURES,CONSTRUCTION,DISCHARGES, OR OTHER ACTMTIES DESCRIBED IN THE APPLICATION Q.E.,PRELIMINARY PLAT APPROVAL,HEALTH DISTRICT APPROVAL,BUILDING PERMIT,SEPA REVIEW,FERC LICENSE, FOREST PRACTICES APPLICATION,ETC.)ALSO INDICATE WHETHER WORK HAS BEEN COMPLETED AND INDICATE ALL EXISTING WORK ON DRAWINGS. TYPE OF APPROVAL 1 n CISSUING AGENCY IDENTIFICATION NO DATE OF APPLICATION DATE APPROVED COMPLETED? SEPA LEAD AGENCY SEPA DECISION SEPA DECISION DATE: 15. HAS ANY AGENCY DENIED AP VAL FOR THE ACTMTY DESCRIBED HEREIN OR FOR ANY ACTMTY DIRECTLY RELATED TO THE ACTIVITY DESCRIBED HEREIN?[IYES JO IF YES,EXPLAIN: - SECTION B-Use for Shoreline and Corps of Engineers permits only: 16- TOTAL COST OF PROJECT. THIS MEANS THE FAIR MARKET VALUE OF THE PROJECT,INCLUDING MATERIALS,LABOR,MACHINE RENTALS,ETC 17. LOCAL GOVERNMENT WITH JURISDICTION: 18. FOR CORPS,COAST GUARD,AND DNR PERMITS,PROVIDE NAMES,ADDRESSES,AND TELEPHONE NUMBERS OF ADJOINING PROPERTY OWNERS,LESSEES,ETC.PLEASE NOTE SHORELINE MANAGEMENT COMPLIANCE MAY REQUIRE ADDITIONAL NOTICE—CONSULT YOUR LOCAL GOVERNMENT. NAME ADDRESS PHONE NUMBER APPlicatm Page 3 of t SECTION C-This -• �section MUST be cempkted for any perm*covered by this application, 19- APPLICATION IS HEREBY MADE FOR A PERMIT OR PERMITS TO AUTHORIZE THE ACTMTIES DESCRIBED HEREIN. 1 CERTIFY THAT I AM FAMILIAR WITH THE ACC R ATE I FURTHER C IN THIS HAT I POSSE AND THAT TO THE BEST OF MY*KW&EDGE AND BELIEF.SUCH INFORMATION IS TRUE,COMPLETE,AND VW*CH THIS 1 FURTHER CERTIFY THAT I RK*fT To THE R AUTHORITY TO UNDERTAKE THE PROPOSED ACTIVITIES. I HEREBY GRANT TO THE AGENCIES TO WHICH THIS APPLICATION IS MADE THE R!(;ffT TO ENTER THE ABOVE-DESCRIBED LOCATION TO INSPECT THE PROPOSED.IN PROGRESS OR COMPLETED WORK 1 AGREE TO START WORK QM y AFTER ALL NECESSARY PERMITS HAVE BEEN RECENED. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT DATE I HEREBY DESIGNATE TO ACT AS MY AGENT IN TIERS RELATED TO THIS APPLICATION FOR PERMIT(S). I UNDERSTAND THAT IF A FEDERAL PERMIT IS ISSUED.I MUST SIGN THE PERMIT SIGNATURE OF APPLICANT DATE SIGNATURE OF LANDOWNER(EXCEPT PUBLIC ENTITY LANDOWNERS,E.G.DNR) DATE THIS APPLICATION MUST BE SIGNED BY THE APPLICANT AND THE AGENT IF AN AUTHORIZED AGENT IS DESIGNATED. 18 U-S.0 51001 provides that Whoever,in any manner within the Jurisdiction d any departrment of agency device•material fad or makes any false,fictitious,or fraudulent statements or representations or makes or uses a'ny false writ States ing or dloeument knowing or covers contain any trick,scheme, o fraudulent shtement a entry,shall be fined not more than 510.000 or imprisoned not more than s years makes soh.LTE - ::,<::•?:i:i:::i:?:::;;i},:�:^,:,;•:,;•.::.;;:::: ..4.. 8Y I.eCJ IJ®"�6L„ r.[.�. /qr/y p - .. �l 1.�QJ dN L.; �rlefure of the sxts#ttlhirefine, (iesribe. #YP ;taf; hocelina{ E�cfa av l3rirle strum, ink® #®goDn fTTarsh,>ba�1, u amp flood ' � lSla fie>bdway, fiefEa; ype f agch,s�ctt ies accretion erosion, high Lank, taw bank, or dfk'e, material such as sand, gravcf, :TTIi�d,clay, rock, riprap; andb,AC1rlt arld type of ta�rikhea ding if uny:} #3: [� e i#that a ly Df tfie pro aced buildings o sfwctures wiff exread a heirght of thirty ftve;#eet gbove#i#e. verage arldr it ff 9eY�1, tntilt-a#c�the p rax rTrate Baca#iorl t f and number of residential units, existing and�ate�#t�l,#tint wt(I lnnvean'obsflt�cf i �r sllft34Y : .y,'ii'Yt}iiStiii,•l�.+i-f:�f 3 ..........# 5 1r1l tt St# fivd#vt3s a condlt}tstla..t..... Yd BSI , tot fattEa in full that poctic�n o:`tfat�Taa stf>r ?rc� Yam} �P.Ofitts <stayia; candtfr0 t g wt�iCh r rovide$;t}�at,. :f..9}•,/ra::..::> :•:,..::.>+:.: .::::.:::.::.::: B::;C1 'iii }!} !Crash cf vacsatice.-If :Vs t :. :?•:•. .} ;; ; ..:?.;:.; ;' rich �..ram.,. f, :::,:,: ::..,::}::. . fan Va.ti�ttcc<ts t�nl ::?:::-fE Ia4s x,t g?w<ti i:....:f f. a.,,..::::...:... , t� :St h rf :.}•:/y •,}{•�:/�:ii:'S}{,/.'.U••;yj4Pjl.4,,'ffi:'}.�i}'t!:/::'}Gi.;f}:'v„:i:::i'W'y'i:.}� '-ff•.��`!-,%'r,'�,'��j•}:. f•.fn.f!fi:/,r.•ir`.rG:C�:<:�:5:::}'!i`::'r'ry•:^:�Ffr?.;-�f ::i�N!-v:i`ii "_— _ �,< rFkrnd)sia,a w�yfa,r.?ff � ittlttd9 pia L7 Y �s 1" �kNlfiaa:rsttis:sty>d*unrl Dtein6er{°/i ,X'.-FXr:.::: �nInrr._��{_ f..: ' kxxi,letn _ I alsrtlsdtla;` .:. h{�}Iea!sir is '. sts %fiiitr►b9f the deer t o'dhe km+cxt pass[Lio twWue�elevat,on Ir-' Utld;a.t and Cor�;r01.116n ocumentatiot7,` t:ert�iasiitatt 3z'tfyui+oci C'wttf+tiation ieesct+wc>d r ._.�--�.----�-----._.-_ �tlrv�yc�cfluafihectlCrz�ine4;r�- �3q(X13's'O(aflt'K,� �fevsted f-(c�us;� _ _ I'ra�Coasftuci>ar;' - f�asiC.txtsirzr;�irni LJ t i These Apencles ar6 Equal OPPOlftJM(y and AMn nathro ACtkn ekrn#pjYelg, — ----— — :::• For SPecle/a000nrrudatlon Deeds,please contact IYle appropda(e apen0y horn MPenr9x B. Application Pape 4 of 4