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HomeMy WebLinkAboutMEP2005-00021 - MEP Application - 3/3/2005 PERMIT NO.: v�j vdU DATE RECEIVED: MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT RECEIVED RESOURCE ORDINANCE (Chapter 17.01 MCC) 411 N. 5TH Street/P.O. Box 279, Shelton, WA 98584 MAR. U 3 2005 ENVIRONMENTAL PERMIT APPLICATION BELFAIR OFFICE MASON ENVIRONMENTAL PERMIT N 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. fi Owner: /')�f' LV r tS-�— O er Mailin Addre s: _ _ he r V Olyc c T NC✓C Site Address: / �(o �O AIAE 74 4vvA 91k S�rt, /�GI City:_y JQS G State:CCL Zip: S-/.?9— Z3��? City: �946,va State Zip:�ien/Title Holder Phone: Daytime(3 6 o ) Address: Fire District#: City: State: Zip: r Signature: 2 Parcel Number:Z 2 - D - DO f1 Legal description: p � G `7 Parcel Size: 3. Directions to ite: go do Ao;r �y v e-e ©•, m��•� U�u� h f S r0 C ak) �:4 ���� V0� 1/Ov► �9�ly y��i W f e; 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 i. Identify c ent use of p perty with existing imp ovements: C Ca yr t C 6. Identify and describe the proposed project,including the type of materials to be used,construction methods,principle dimensions and other pertinent information(Attu additional stwets if nee d : 1 4 k c k ecl 7. Will there be an alteration of a wetland and/or wetland vegetation area? Yes OWo 8. Any water on or adjacent to property: Saltwater ❑ Lake;R River ❑ Pond ❑ Wetland 0 Seasonal Runoff ❑ Other g. If septic is located on project site,include records. Connect to septic? FV Community Septic? ❑ Public Water Supply? ❑ Well? W 10. Type of Job: New X Add 0 Alt ❑ Repair ❑ Demolition ❑ Other This permit is anted ursuant to the P �' p 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: $350.00 t Show the following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Water Lines Driveways Drainage Plans Shorelines Septic System Topography Indicate Directi nal by(N,S,E,W,etc.) Proposed Improvements Easements In relation to plot plan Name if Flanking Street i APPLICANT TO DRAW SITE PLAN BELOW:1 Q ;:� S-0 V - 1�1 V1 APPLICANT TO DRAW TOPOGRAPHY BELOW: I DEPARTMENTAL REVIEW FOR OFFICE USE ONLY COMMENTS Planning: Environmental Health: Building Plan Review: Occupancy Group: Fire Marshal: Other: Conditions: FEES Total fees: Accepted by: Date: M• COUNTY RESOURCE MASON C 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. DATE OWNER APPLICANT MASON COUNTY RESOURCE ORDINANCE July 2003 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.