HomeMy WebLinkAboutMEP2005-00035 - MEP Application - 4/18/2005 J
PERMIT NO.: ?Q[ -
DATE RECEIVED:
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE ORDINANCE (Chapter 17.01 MCC)
411 N. 5TH Street/P.O. Box 279,Shelton, WA 98584
ENVIRONMENTAL PERMIT APPLICATION
MASON ENVIRONMENTAL PERMITX 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:_�S rrl Owner Mailing Address:
Site Address:
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City: Eel fh \ State_112aZip: OSSATitle Holder
01Qb l -An- bPhone:Daytime
Fire District#:_ Address:60S S•'00 P nel cA l 5�f) r
City: B0,Gl State:CAOIr _Zip g�3
Signature: v
2' Parcel Number: _ _ Legal description: E
Parcel Size: }('
3. Directions to site:
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State what sections require a permit: In-Holding Lands,Chapter 17.01.062 ❑
4' 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 €�
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5.
Identify current use of property with existing improvements:
6.
Identify and describe the proposed project,including the type of materials to be used,construction methods,
principle dimensions and other pertinent information(Attach additional sheets if
needed):
7. Will there be an alteration of a wetland and/or wetland vegetation area? Yes ❑ No,)
8. Any water on or adjacent to property:
Saltwater ❑ Lake ❑ River ❑ Pond ❑ Wetland ❑ Seasonal Runoff ❑
Other_
9. If septic is located on project site,include records.
Connect to septic? Community Septic? ❑ Public Water Supply? ❑ Well?
10.
Type of Job: New`k 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rescinded pursuant to the event the permittee fails to comply with the conditions of this ordinance.
MASON ENVIRONMENTAL PERMIT: $510.00/$305.00(with another permit)
MASON CONDITIONAL USE ENVIR.PERMIT: $1,225.00
MASON RESOURCE ORDINANCE VARIANCE: $1,225,00
HEARINGS EXAMINER: $490.00
I:\PLANNING\R&GPAC\ENVIRONMENTAL REVISED 0I-04-05
Show the followinq on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Water Lines Driveways
Drainage Plans Shorelines
Septic System Topography
Proposed Improvements Easements Indicate Directional by(N,S,E,W,etc.)
Name if Flanking Street In relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW:
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APPLICANT TO DRAW TOPOGRAPHY BELOW:
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DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
COMMENTS
Planning:
Environmental
Health:
Building Plan
Review:
Occupancy
Group:
Fire Marshal: -
Other:
Conditions: FEES
Total fees:
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Accepted by: Date:
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MASON COUNTY RESOURCE ORDINANCE July 2003
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.
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DATE
OWNER
APPLICANT 7
MASON COUNTY RESOURCE ORDINANCE July 2W3
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.