HomeMy WebLinkAboutSHX2000-00023 JARPA-Replace 2 Pilings - SHX Application - 10/28/2000 .afpllgRU,77iFi�W1*Ii+7', - -
.}: :`,;.,,..:v{<.:::w:...
.'r.2�• k: :.�.:-:vTii`::ti..,�•}:;::i'c::;:;:}�;tiR::::::�::;:;�:�;:::k:.:}ss'.}:.:;:;•;:•:::.,..
:k2a.: :.A,h�c4:�-.4X. :�:�{,• Y' "'%k`t%Th:.,::>, .:a-?.:.: :w,-::::.:�: -:.a:.:::.::...
:c. �f -�'•�' ..r\::.}t.<,{.7. :.Vi�ki2. ..td;4",,.:.�<YsTsv i:: 2 <::<?.. ..<;:-s::•>sx'': •::a:::,.:i»�f�::i:T:::};
g� }'\ �._. .:��:Yt".3'` iT +� /����yytt.k }'9<i%}.< '<- 'li.•'.tt<:,..,,•:�:;:`.h:'s£`'}::y:;v"s'�'' r`nL�i
'at f.o.�.'.,+M'.l ..�.. ::L1 %Z1JlY[�: .:C'. .7 :Kw• ;,<;a::r<r lam::%'�'.:� f
<s ?�: •. .:v-},s .2SF?."rl }:'Ci' ti.,�.�;t. ,..`.}vs':-> r; c"^.'f'<•'.:� .`.:s�.:. .::::: .s.:::s}}:<,rr��;'�,t< �f
r
t3tT� .�'„• ... ...:.:'iK'.....:..�'..- .f:.J �..�.:a^.fff�c�'�. %"`:' •w:% ::: y� "�;;t;°`,, f r '
W. :.r. -..:CV?.C::; .:<>t:i�::._..:4�. :..�`-. k.:Q:. .�:, ...�f,•` "%<•rj:'r"'iT}•r
.:f--.... W" ,
,y rr't b {::":-::. '-::...: /.. .f f4•:.}::.}•<:.:.:.:;.:s .E::::::::.::..r:C:::::..:::::.::.�:n.:.<t:......:.
I I DARPA FORMI� • � I � �
(roI use In Washington State) -z
PLEASE TYPE OR PRINT IN BLUE OR BLACK INK
Based on the preceding checldist,I am sending copies of this application to the following: (check a#that apply)
(� Local Government for shoreline: WSubstantlal Development ❑Conditional Use ❑Vadanc ,R Exemption;or,if applica le
❑ Floodplain Management ❑Critical Areas Ordinance
(J� Washington Department of Fish and Wildlife for HPA
I�Q 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 perm/es covered by this application. Be sure to also complete Section C(Signature Bloch for all permit
applications.
1.APPLICANT ll /t �/� � / `
9-e-5 —a -- IAk,�e (ZV park r Mar��c` CCI VI��S LIVLA it I�1�11"y v-e+ Ali a t'sC Vl 1
MAILING ADDRESS `j
27o01 V- its gwy 1-01 wA T9S4S
WORK PHONE
HOME PHONE FAX M
36e01 1
Kan agent Is acting for the applicant during the permit process,complete#2.
2.AUTHORIZED AGENT
MAILING ADDRESS
WORK PHONE HOME PHONE FAX fl
9.RELATIONSHIP OF APPLICANT TO PROPERTY: OWNER ❑PURCHASER ❑LESSEE ❑OTHER:
,.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)
2loa?0 N. t,-5 1k.v y K>1 i00d5P01 (IM0-501-) Wow g96V8
wATEReoDY
/ od 0-0-t1t OL( TRIBUTARY OF
1/4 SECTION TOWNSHIP RANGE GOVERNMENT LOT SHORELINE DESIGNATION
2 3r( 3 N 31
ZONING DESIGNATION
TAX PARCEL NO.: DNR STREAM TYPE,IF KNOWN
32331 23q aOz4
Application Page 1 of A
4
• PROPERTY. ATE"'T"AND- 06SCRIBE TW CURRENT USE OF THE TM,AND STRUCTURES E)OSTING ON THE PROPERTY. ANY PORTION OF 71iE PROPOSED ACTiV(TY IS •` a
ALREADY COMPL-rpD ON
gy PaLIV �ry �Ga`� S'�a/l , 51 /�tic+.ic�
�" u s�c oQv c�
L�rve wP , 5ea'4od /1/la.Lk c 1( N�7`
rVl PK(54r-t14C-A, --X14 �0 re- �t Ye)`. �l
IS THE PROPERTY AGRICULTURAL LAND?❑YES ONO
ARE
A USDA
YES NO
74. DESCRIBE THE PROPOSED WORK:COMPLETE PLANS AND SPECIFICATIONS SHOULD BE PROVIDED FOR ALL WORK WATERWARD PROGRAM OF T E ORDIINARY HIIGH WATER R MARK OR
Propo5ed nel ife4 Z I1
C
7b.DESCRIBE THE PURPOSE OF THE PROPOSED WORK.
7c. DESCRIBE THE POT
ENTIAL IMPACTS TO CHARACTERISTIC USES OF THE WATER BODY THESE USES MAY INCLUDE FISH AND AQUATIC LIFE,WATER QUALffY,WATER
SUPPLY,RECREATION,and AESTHETICS. IDENITFY PROPOSED ACTIONS TO AVOID,MINIMIZE,AND MITIGATE DETRIMENTAL IMPACTS,AND PROVIDE PROPER PROTECTION
�etiv>i✓"� /� P;11vL`, t r phi cItwe,-t � 5c��y-t L �,1<►.�
WOLLid 6t l o pl e7. cl avk eKA erlf.� "d
PREPARATION OF DRAWINGS: SEE APPENDIX A-SAMPLE DRAWINGS AND CHECKLIST FOR COMPLETING THE DRAWINGS. ONE SET OF ORIGINAL OR GOOD QUALITY
REPRODUCIBLE DRAWINGS MUST BE ATTACHED. 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 DRAWINGS ON 8-f/2 X 1 f INCH SHEETS. URGER DRAWINGS MAYBE REQUIRED BY OTHER
AGENGES
8.WILL THE PROJECT BE CONSTRUCTED IN STAGES?
❑YES NO
PROPOSED STARTING DATE: ZDO
ESTIMATED DURATION OF ACTIVITY:
9.CHECK IF ANY STRUCTURES WILL BE PLACED:
,dWATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE FOR FRESH OR TIDAL WATERS,AND/OR
y(WATERWARD OF THE MEAN HIGH WATER LINE IN TIDAL WATERS
10 WILL FILL MATERIAL(ROCK,FILL,BULKHEAD,PILINGS OR OTHER MATERIAL)BE PLACED:
❑WATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE FOR FRESH WATERS? �; '
I_ IF YES,VOLUME(CUBIC YARDS) /AREA (ACRES
❑WATERWARD OF THE MEAN HIGHER HIGH WATER FOR TIDAL WATERS?
IF YES,VOLUME(CUBIC YARDS) /AREA (ACRES)
'1.WILL MATERIAL BE PLACED IN WETLANDS?
IF YES: ❑YES NO
A.IMPACTED AREA IN ACRES j
8 HAS A DELINEATION BEEN COMPLETED? IF YES,PLEASE SUBMIT WITH APPLICATION
C.HAS A WETLAND REPORT BEEN PREPARED? IF YES,PLEASE SUBMIT WITH APPLICATION ❑YES ItI NO
D TYPE AND COMPOSITION O FILL MATERIAL(E.G..SAND,ETC.) ❑YES ]`NO
E.MATERIAL SOURCE
F_LIST ALL SOIL SERIES(TYPE O SOIL)LOCATED AT THE PROJECT SITE,R INDICATE IF THEY ARE ON THE COUNT'Y'S LIST OFHYDRIC SOILS. SOILS INFORMATION CAN BE
OBTAINED FROM THE NATURAL RESOURCES CONSERVATION SERVICE(MRCS)
12 WILL PROPOSED ACTIVITY CAUSE FLOODING OR DRAINING O WETLANDS?
Cl YES I NO
Appllcabon Page 2 of 4
I
IF YES,IMPACTED AREA IS_ACRES
13.W'.i-XCAVATION OR DREDGING BE REQUIRED IN WATER OR WETLANDS? ❑YES
' NO
IF YES: °
I' A.VOLUME:_(CUBIC YARDSyAREA_(ACRES)
B COMPOSMON 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 ACTIVITIES DESCRIBED IN THE APPLICATION p.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 ISSUING AGENCY IDENTIFICATION NO DATE OF APPLICATION DATE APPROVED COMPLETED?
SEPA LEAD AGENCY SEPA DECISION SEPA DECISION DATE
15. HAS ANY AGENCY DENIED APPR VAL FOR THE ACTMTY DESCRIBED HEREIN OR FOR ANY ACTMTY DIRECTLY RELATED TO THE ACTIVITY
DESCRIBED HEREIN?❑YES KNO IF YES,EXPLAIN:
SECTION B-Use for Shoreline and Corps of Engineers permfis 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: Z 2,00 uri4L SoQ
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
_]u lvj e " rc L(v q 00 4-5 a6jt WA C 8 J'f s a 8 7 7- 5_1
Application Pape 3 of 4
SECTION C-This section MUST be cot pm(ed for any Peffrott covered b this '
Y application.
19. APPLICATION IS H ERMBY MADE FOR A PERMIT OR PERMITS TO AUTHORIZE THE ACTIVITIES DESCRIBED HEREIN. I CERTIFY THAT I AM FAMILIAR WITH THE 0
*f;ORMATON CONTAINED IN THIS APPLICATION,AND THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF,SUCH INFORMATION IS TRUE,
WHICH THIS
1 FURTHER CERTIFY THAT 1 POSSESS THE AUTHORITY TO UNDERTAKE THE PROPOSED ACTMTIES. I HEREBY GRANT TO THE AGENCIES O D
WFi1CF1 THpS APPLICATION IS MADE,THE RIGHT TO ENTER THE ABOVE-DESCRIBED LOCATION TO INSPECT THE PROPOSED.IN-PROGRESS OR COMPLETED
WORK 1 AGREE TO START WORK ONLY AFTER ALL NECESSARY PERMITS HAVE BEEN RECEIVED.
SIGNATURE OF APPLICANT GR AUTHORIZED AGENT
DATE
I HEREBY DESIGNATE
TO ACT AS MY AGENT IN MATTERS 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§1001 provides that Whoever,in any manner within the jurisdiction of any department or agency of the United States knowingly falsifies,conceals,or covers up by any trick,scheme,or
device a material fact or makes any false,fictitious,or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false,fictitious,or
fraudulent statement or entry,shall be fined not more than$10,000 or imprisoned not more than 5 years or both. -
COMPLETED BY LOCAL OFFICIAL
Nature at tha existing Shoreline, escri e typo taf shOfelir]P, such as marine, stream, lake, lagoon, Tnarsh bap, s:4� , flood
Plain, flaodv�°ay, rie�tta 5 "a€beach,such as a amp
ccretion, erosion, high bank, 1OW bank, or dike; nlatc=iial such at- sand, gravel,
mud,clay, rock, riprapa and uxtcnt and type of buikheading, if any;}
Jn the event that any of it,
prot)osed buildings c1r strLtatutt-s Will,:exceed a height of tr,fi ty-five fart abc ve the avefag c�r�Idc
�elrei, lndicte thepprnx;rrtate location of anti urrrbor of resid
en)tlaItinits exisfingnd iantet tial,that wl(i have inn obsffucfed
Yttgw
` `` ftfTB apPlsGailDfT tliVd# as a cond banal use or v
atsanco, tot forth in full that particn of the master Pfaaram which PIOV�dcs that
e P�Ss tts shay be a condltionai use, or, in the Case of a variance, from which the variance i 't ein Fuugt f:
t®Cation of f:lropose4
El Fkaodwtry �; 1J4yuvrF ire � 5(Kly�ar'FEbxl,>:aaia t� C3t tsd�`apudyAtf3u 0 ti ri,ze ,tgr lip ltlod
#'Etvili#'IFdM G:arruxtuiadty.I7arset 3larnPscx
Tba baw 100-r"Ur uk --Jpwm*ieralikln or zfRr?ti tfumW TO ey"dovelo m
7t kxvett passer" txilkltng oh vatKxt i'
Building 4nd G0r-5"U(ti0rt Doc:urrientation.
��[t�acatiati I2c+iluwtx4 _ C;+x1if�;:atinta Ei«x:ccverd .
fku<x3 F'r'oM)np ('t»-Crntglttkttkm : ___.
_ 3-''os;t-GbltYtxUCfltYtf
i;g43Y�fnc1�J41SN1fJ _ _ H7stf°(;cxltclttt»'llckt7_.u.._,.._
Af[�ratir�ttic�i,K/efnrwpy��
These Agencies are Equal OPPOftunity and AMmilathro Action enV)1oyom. — -
For aPeclal&WofrYnodatllon needs,Please coneact the appi upd8te agency from Appendix B.
Application Page 4 of 4