HomeMy WebLinkAboutSHX2003-00003 JARPA Dock - SHX Permit / Conditions - 1/13/2003 PSOlt%-sTATFO MASON COUNTY
c DEPARTMENT OF COMMUNITY DEVELOPMENT
o A U �N Planning Division
o T = P 0 Box 279, Shelton,WA 98584
ZOO N Y O~ (360)427-9670
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1864
Exemption from Shoreline Management Act
Case No.: SHX2003-00003 Substantial Development Permit Requirement
The Proposal By: STEVE LAMBERT
9280 OLD BELFAIR HWY
BREMERTON,WA 98312
To undertake the following development:
8' X 50' dock w/ 8' X 12' "L" attached to right at end.
Within Wooten Lake and/or its associated wetlands is exempt from the requirement of substantial development because the
development is categorized under WAC 173-1-040(H)as being category
H-dock
Please contact Rick Mraz at ext 577 if you have any questions.
1
Issued: 1/13/2003
Expires: 1/13/2004 Authorized Local Government fficial
cc: APPLICANT WDFW- USACOE
WDOE
TRIBAL COUNCIL �J
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JARPA FORM
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PLEASE TYPE OR PRINT IN BLUE OR BLACK INK ��+�.,✓Free£
Based the preceding checidist,I am sending copies of this application to the following: (check a#that apply) �,/
Local Government for shoreline: ❑ Substantial Development ❑Conditional Use ❑Variance & Exemption;or,if applicable
❑ Floodplain Management ❑Critical Areas Ordinance
f Was
Department of Fish and Wildlife for HPA
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Department of Ecology for: Approval to Allow Temporary Exceedance of Water Quality Standards
❑401 Water Quality Certification Nationwide Permits
❑l Washington Department of Natural Resources for:❑Aquatic Resources Use Authorization Notification
U1 Corps Engineers for:VSection 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.
FIAPPLICANT
s'f�•c t �AILING ADDRESS9?� ZORK PHONE
HOME PHONE Fp,X p
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If an agent Is acting for the applicant during the permit process, complete#2.
2.AUTHORIZED AGENT
MAILING ADDRESS
WORK PHONE HOME PHONE FAX p
FRELATIONSHIPOF APPLICANT TO PROPERTY: OWNER ❑PURCHASER ❑LESSEE ❑OTHER.
S,AND PHONE NUMBER OF PROPERTY OWNER(S),IF OTHER THAN APPLICANTL
S.LOCATION(STREET ADDRESS.INCLUDING CRY,COUNTY AND ZIP CODE,WHERE PROPOSED ACTIVITY EXISTS OR WILL OCCUR)
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WATERBOOY
IBUTARY OF
1N SECTION TOWNSHIP RANGE GOVERNMENT LOT SHORELINE DESIGNATION
TH
2� r 1 2 a1i ZONING DESIGNATION
TAX PARCEL NO ONR STREAM TYPE.IF KNOWN
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Appf"t.on Page 1 of 4
13-`Ivx L EXCAVATION OR DRIDGMJO BE REOU UD IN WATER OR WETLANDS? ❑YES NO
IF YES:
A VOLUME_(CUBIC YARDS)IAREA_(ACRES)
8.COMPOSITION OF MATERIAL TO BE REMOVED.
C.DISPOSAL SITE FOR EXCAVATED MATERIAL:
D.METHOD OF DREDGING:
14 LIST OTHER APPLICATS,APPROVALS,OR CERTIFICATIONS FROM OTHER FEDERAL,STATE OR LOCAL AGENCIES FOR ANY STRUCTURES,CON STR UCTION,DISCHAR
ION GES,
OR OTHER ACTIVITIES DESCRIBED IN THE APPLICATION Q E PRELIMINARY PUT 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?
o (.t.S Arw S
SEPA LEAD AGENCY SEPA DECISION SEPA DECISION DATE
15. HAS ANY AGENCY DENIED APPROVAL FOR THE ACTIVITY DESCRIBED HEREIN OR FOR ANY ACTIVITY DIRECTLY RELATED TO THE ACTMTY
DESCRIBED HEREIN?❑YES I►�NO IF YES,EXPLAIN:
V
SECTION B - Use for Shoreline and Corps of Engineers permits only:
16 TOTAL COST PROJECT. TH IS MEANS THE FAIR MARKET VALUE OF THE PROJECT,INCLUDING MATERIALS.LABOR,MACHINE RENTALS,ETC
uv
1% LOCAL GOVERNMENT WITH JURISDICTION:
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18 FOR CORPS,COAST GUARD,AND DNR PERMITS,PROVIDE NAMES,ADDRESSES,AND TELEPHONE NUMBERS OF ADJOINING PROPERTY OWNERS,LESSEES,ETC.PLEASE
NOTES SHORELINE MANAGEMENT COMPLIANCE MAY REQUIRE ADDITIONAL NOTICE-CONSULT YOUR LOCAL GOVERNMENT.
NAME ADDRESS PHONE NUMBER
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APPl"tion Page 3 of 4