HomeMy WebLinkAboutFPA2007-00002 - FPA Application - 2/28/2008 RECEIVED
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° rA MASON COUNTY JAN 17 2001
�,, DEPARTMENT OF COMMUNITY DEVELOPMENT
2266
Mason County Bldg. III, 426 West CedarVtr et CEDAR STs
—- - �< PO Box 186, Shelton, WA 98584
1854 www.co.masonma.us (360)427-9670 Belfair(360)275-4467 Elma (360)482-5269
FOREST PRACTICES APPLICATION/NOTIFICATION
F eAa 0 C) (DC)nc',�) Type IV General
This application should be accompanied with an Environmental Checklist(SEPA) as well as an activity map/site plan which addresses
items listed below.
TYPE OR PRINT IN INK:
1. Landowner,Timber Owner and Operator information.
Legal Name of LANDOWNER Legal Name of TIMBER OWNER Legal Name of OPERATOR
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Mailing Address: Mailing Address: Mailing Address:
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City, State,Zip City, State,Zip City,State,Zip
lice" 98-68g ISVszlfcm,
Phone 4;90 f�7-•Y4 70 Phone( ) Phone
�60 SS 3�
Email: Email: Email:
2. Contact person information.
Contact Person Phone,�-7 4J 7 74 G��
Ake, Email: e-c e,6 CW ago. &#fw407 4agp. VS
3. If you are harvesting timber,enter the Forest Tax Reporting Account Number of the Timber Owner: Al A
For tax reporting information or to receive a tax number,call the Department of Revenue at(800)548-8829.
4. Legal description where the forest practices will occur.
Parcel Number Sub Division '/.'/. Section Townshi Ran e
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4sooLZ�mse�oe AWN k1 Z Zon GtJe
v ooze esA146 ,�f — Q o
�o2lesaoo;Q W NE' 2 a o
5. Ans
wer each question as it applies to your proposed forest practice.
a. []No. Yes. Is the activity within an urban growth area?
b. No. [] Yes. Is the activity within a public park?
C. No.
[] Yes. Is the activity within 500 feet of a public park? Park name:
d. No. [] Yes. Is the activity located on lands platted after January 1, 1960?
e. No. [] Yes. Is the activity within 200 feet of saltwater lake river/creek/stream pond
wetland seasonal runoff slopes which exceed 15%?
f. What is the expected duration of FPA?
Proposed start date: ,; ! 90 7 U01Proposed end date: = Z Q
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