HomeMy WebLinkAboutSHX2006-00085 JARPA Moorage Float - SHX Permit / Conditions - 9/25/2006 oN_STATE MASON COUNTY
BPS C ° DEPARTMENT OF COMMUNITY DEVELOPMENT
o n o �m Planning Division
► o N
1 Z P O Box 279, Shelton, WA 98584
Z� N y ti (360)427-9670
OJ �O
1864
Exemption from Shoreline Management Act
Case No.: SHX2006-00085 Substantial Development Permit Requirement
The Proposal By: GORDON KAUHANEN
24 CARIBOU CT
MONTEREY,CA 93940
To undertake the following development:
MOORAGE FLOAT
Within HOOD CANAL and/or its associated wetlands is exempt from the requirement of substantial development because the
development is categorized under WAC 173-27-040(2) as being category
A-does not exceed $2.500.00
Please contact Kell McAboy at ext 363 if you have any questions.
Issued: 9/25/2006 ��clLco
Expires: 9/25/2008 Authorized Local Government Official
cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL
-GENCY.`17SE ONL Y : Y
i .
Agency.Reference#: . : Date`ei cs'ved
Circulated by (local•)"rwt`or agency)
JOINT AQUATIC RESOURCES PERMIT APPLICATION FORM (1ARPA)
(for use in Washington State)
PLEASE TYPE OR PRINT IN BLACK INK
❑Application for a Fish Habitat Enhancement Project per requirements of RCW 77.55.290. You must submit a copy
of this completed DARPA application form and the (Fish Habitat Enhancement,DARPA Addition)to your local
Government Planning Department and Washington Department of Fish&Wildlife Area Habitat Biologist on the same day.
NOTE: LOCAL GOVERNMENTS—You must submit any comments on these projects to WDFW within 15 working days.
Bed on the instructions provided, I am sending copies of this application to the following: (check all that apply)
Local Government for shoreline:❑Substantial Development ❑Conditional Use ❑Variance X Exemption ❑ Revision
❑ Floodplain Management ❑Critical Areas Ordinance
Washington Department of Fish and Wildlife for HPA(Submit 3 copies to WDFW Region)
❑ Washington Department of Ecology for 401 Water Quality Certification(to Regional Office-Federal Permit Unit)
❑ Washington Department of Natural Resources for Aquatic Resources Use Authorization Notification
❑ Corps of Engineers for: ❑ Section 404 t Section 10 permit
❑ Coast Guard for General Bridge Act Permit
❑ For Department of Transportation projects only: This project will be designed to meet conditions of the most current Ecology/Department of
Transportation Water Quality Implementing Agreement
SECTION A-Use for all permits covered by this application. Be sure to ALSO complete Section C(Signature Block)for all permit applications.
1.APPLICANT
MAILING ADDRESS
WORK PHONE E-MAIL ADDRESS OME PH NE FAX#
If an agent is acting for the applicant during the permit process,complete#2. Be sure agent signs Section C(Signature Block)for all permit
applications
2,AUTHORIZED AGENT
MAILING ADDRESS /
521 N G Ufa r�vP, �q��3��
WO PHO 57
G� C � �C ADDRESS PLC ,1�/ YOME C 3�j PHONE F/ #(�Cry
3.RELATIONSHIP OF APPLICANT 70 PROPERTY: p-MNE p PURCHASER ❑LESSEE ❑OTHER:
4.NAME,ADDRESS,AND PHONE NUMBER OF PROPERTY OWNER(S),IF OTHER THAN APPLICANT:
5.LOCATION(STREET ADDRESS,INCLUDING CITY,COUNTY AND ZIP CODE,WHERE PROPOSED ACTIVITY EXISTS OR WILL OCCUR)
/D& G14i�i'�r
LOCAL GOVERNMENT WITH JURISDICTI ON(CITY OR COUNTY) Sn�� C�I�tiN
WATERBODY YOU ARE WORKING IN
C n�,i A L TRIBUTARY OF WRIA#
IS THIS WATERBODY ON THE 303(d)LIST?YES 0 NO 0—
IF WHATPARAhfETER(S)7
http://w,.,,,w.ecv,wa.gov ro /w /link-sf iced wtrs.html WEBStTEFOx303d
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11.WILL MATERIAL BE PLACED 1N WETLANDS? ❑YES O
IF YES:
A. IMPACTED AREA IN ACRES:
B. HAS A DELINEATION BEEN COMPLETED? IF YES,PLEASE SUBMIT WITH APPLICATION. ❑YES ❑NO
C. HAS A WETLAND REPORT BEEN PREPARED? IF YES,PLEASE SUBMIT WITH APPLICATION. ❑YES ❑NO
D. TYPE AND COMPOSITION OF FILL MATERIAL(E.G.,SAND,ETC.):
E. MATERIAL SOURCE:
F. LIST ALL SOIL SERIES(TYPE OF SOIL)LOCATED AT THE PROJECT SITE,&INDICATE IF THEY ARE ON THE COUNTY'S UST OF HYDRIC SOILS.SOILS INFORMATION CAN BE OBTAINED
FROM THE NATURAL RESOURCES CONSERVATION SERVICE(MRCS):
G. WILL PROPOSED ACTIVITY CAUSE FLOODING OR DRAINING OF WETLANDS? ❑YES ❑NO
IF YES,IMPACTED AREA IS_ACRES OFDRAINED WETLANDS.
NOTE: If Your project.*11 impact greater than 54 of an acre of wetland,submit a mitigation plan to the Corps and Ecology for approval along with the DARPA form
NOTE a 401 water quadfy certffcation wil(be required from Ecology in addl3on to an approved mitigation plan d your ro t p !ec impacts weflends that we: eJ greater than 14 eve in see,or
b)tidal wetiar?ds or"tWxis ad,%acent to Lida!Hater. Phase submit the JARPA/orm and mitigation plan to Ecology for an individual 401 cerd cation y a)orb)appbes.
12. STORMWATE.RCOMPLIANCE FOR NATIONWIDE PERMITS ONLY: I'J/A
THIS PROJECT IS(OR 1MLL BE)D SIGNED TO MEE-7 ECOLOGY S MOST CURRENTSTORMWATER MANUAL,OR AN ECOLOGY APPROVED LOCAL STORMWATER MANUAL Q YES ❑NO
IF YES-WHIC..H MANUAL WILL YOUR PROJECT BE DESIGNED TO MEET
!(NO-FOR CLAN WA?'R ACT SECTION 401 AND 404 PERMITS ONLY-PLEASE SUBMITTO ECOLOGY FOR APPROVAL, ALONG WITH THIS JARPA APPLICATION,DOCUMENTATION THAT
DEMONSTRATES TFia 3TORMWA7E4 RUNOFF FROM YOUR PROJECT OR ACTIVITY WILL COMPLY tMTH THE WATER QUALITY STANDARDS,WAC 173.201(A)
13.WILL EXCAVATION OR DREDGING BE REQUIRED IN WATER OR WETLANDS? ❑YES
MIK
IF YES:
A. VOLUME: (CUBIC YARDS)!AREA (ACRES)
B. COMPOSITION OF MATERIAL TO BE REMOVED:
C. DISPOSAL SITE FOR EXCAVATED MATERIAL:
D. METHOD OF DREDGING:
14.HAS THE STATE ENVIRQ M AL POU Y ACT(SE�BEEN COMPLETED? ❑YES NO
SEPA LEAD AGENCY: t� /���P� j I SEPA DECISION: DNS,MDNS,EIS,ADOPTION,EXEMPTION DECISION DATE(END OF COMMENT PERIOD):
SUBMIT A COPY OF YOUR SEPA DECISION LETTER TO AS REQUIRED FOR A COMPLETE APPLICATION
15.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(I.E.,PRELIMINARY PLAT APPROVAL,HEALTH DISTRICT APPROVAL,BUILDING PERMIT,SEPA REVIEW,FEDERAL ENERGY REGULATORY
COMNASSION UCENSE(FERC),FOREST PRACTICES APPUCATION,ETC.)ALSO INDICATE WHETHER WORK HAS BEEN COMPLETED AND INDICATE ALL EXISTING WORK ON DRAWINGS.
NOTE:FOR USE WITH CORPS NATIONWIDE PERMITS,IDENTIFY WHETHER YOUR PROJECT HAS OR WILL NEED AN NPDES PERMIT FOR DISCHARGING WASTEWATER AND/OR STORMWATER.
TYPE OF APPROVAL ISSUING AGENCY IDENTIFICATION DATE OF APPLICATION DATE APPROVED COMPLETED?
baIL - .� i to-<,.-,r-f Cou"Tl,` NO.
�V I rcAll
6.HAS ANY AGENCY WED APPROVAL FOR THE ACTIVITY YOU'RE APPLYING FOR OR FOR ANY ACTIVITY DIRECTLY RELATED TO THE ACTIVITY DESCRIBED
HEREIN?❑YES MNO IF YES,EXPLAIN:
TARDA Reviceri 7/(17('nntant fhr CtafP nfWachinatnn (lffre nfPPrrrtit AccietanrtP fnr latact vArcinn ;r;(S/dfl7_7O,7 nr S2(1(11017_Ond� �
SECTIONS-Use for Shoreline and Corps of Engineers permits on(Y'
7a.TOTAL COST OF PROJECT.THIS MEANS THE FAIR MARKET VALUE OF THE PROJECT,INCLUDING MATERIALS,LABOR,MACHINE RENTALS,ETC. 31 34'-, C)
7b. IF A PROJECT OR ANY PORTION OF A PROJECT RECEIVES FUNDING FROM A FEDERAL AGENCY,THAT AGENCY IS RESPONSIBLE FOR ESA CONSULTATION. PLEASE INDICATE IF YOU
WILL RECEIVE FEDERAL FUNDS WHAT FEDERAL AGENCY IS PROVIDING THOSE FUNDS. SEE INSTRUCTIONS FOR INFORMATION ON ESA—
FEDERAL FUNDINIG II YES arpo IF YES,PLEASE UST THE FEDERAL AGENCY
I&LOCAL GOVERNMENT WITH JURISDICTION:
bift564-i COUNTY'
19,FOR CORPS,COAST GUARD,AND DNR PERMITS,PROVIDE NAMES,ADDRESSES,AND TELEPHONE NUMBERS OF ADJOINING PROPERTY OVVNERS,LESSEES,ETC...
PLEASE NOTE SHORELINE MANAGEMENT COMPLIANCE MAYREQUIRE ADDITIONAL NOTICE—CONSULT YOUR LOCAL GOVERNMENT.
NAME ADDRESS PHONE NUMBER
LY E ilPti214 57b1cE-5 'L& I rA p. s},.iT4$A423"t-t CA
Box3 UN/NQ of -L
i
SECTION C-This section MUST be completed for any Pennit covered by fis application
0.APPLICATION IS HEREBY MADE FOR A PERMIT OR PERMITS TO AUTHORIZE THE ACTIVITIES DESCRIBED HEREIN. I CERTIFY THAT I AM FAMILIAR WITH THE
INFORMATION CONTAINED IN THIS APPLICATION,AND THATTO THE BEST OF MY KNOWLEDGE AND BELIEF,SUCH INFORMATION IS TRUE,COMPLETE,AND
CCURATE. I FURTHER CERTIFY THAT I POSSESS THE AUTHORITY TO UNDERTAKE THE PROPOSED ACTIVITIES. I HEREBY GRANT TO THE AGENCIES TO WHICH
HIS APPLICATION IS MADE,THE RIGHT TO ENTER THE ABOVE-DESCRIBED LOCATION TO INSPECT THE PROPOSED,IN-PROGRESS OR COMPLETED WORK I
AGREE_TC START WORK ONLY AFTER ALL NECESSARY PERMITS HAVE BEEN RECEIVED.
SIGNA OF APPLICANT DATE
77x5;.� - 'la"� 9 g0
SiGNATUR F A RZED ATE
Z6 d
I HEREBY DESIGNA /�rY1 Y L�tT�V!�'}r-� /vI A-R t rJt� 5"A r--V"5 'F DATE
TO ACT AS MY AGE IN MATTERS RELATED TO THIS APPUCA N FOR PERMIT UNDERSTAND THAT(F A FEDERAL PERMIT IS ISSUED,
I MUST SIGN THE PERMIT.
�
� a. O
SIGNATURE OF'APPUCANT DATE / O
SIGNATURE OF LANDOWNER(EXCEPT PUBLIC ENTITY LANDOWNERS,E.G.DNR)
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,schema,or device a
nW arial fact or makes any false,fictitious,or fraudulent statements or representations or makes or uses any false writing or document knowing some to contain any false,fictitious,or fraudukant statement or
entry,shall be fired not more than$10,000 or imprisoned not more than 5 years or both.
ti COMi'LETE)7 BY LOCI L E3FFICtAL
R fi�Fa#urof#he existing sfrareitrte LC?escnlae type Ofshorelirle such as manna streartx lake,lagoola�marsh,bog,swamp,flnod
:plain,46odWa ,deffa;t�lPe of beach such as accfefian,erosion,high baTtic low bank larfittca,TTtatecial such as sacxd gravel, rrlutl cta
.;mck,nprap�and�exteztt and p�ofbu�kheading,zfi fiy.
ift the event Man of 313e prapD$ed buildings orsWctures Wits eX666 ;height 0 tturEy-fire feet above She average grade
lsvet,tr dtca#e fhe appro�c�Fnate lacafton of and nutaaber of reslde»tial unft ..exisftng acid potenftai,fha#wilt i� ue �T o(� Mev
:..
if the apphatlora lrl�o7ves a caxldltlonal use car variance set forth 1f)foil that poftlon 4f the master}arograrrt wxuch provlds the# :
the proposed use coax be a condtttonal user or;!n the case of vanartce,front whtcf}the vanance is tieing sought
These Agencies are Equal Opportunity and Affirmative Action employers.
For special accommodation needs,please contact the appropriate agency in the instructions.
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