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Home My WebLink AboutSHX2002-00031 JARPA - SHX Permit / Conditions - 7/25/2002 MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Courthouse Annex RECEIVED a E P.O. Box 279, Shelton, WA 98584 x2-,P (360) 427-9670 02 W& THE SHORELINE PERMIT APPLICATION ATION 4+ (j W1 fTM IV- PERMIT NO. S ORELINE SUBSTANTIAL DEVELOPMENT u SHORELINE-VARIANCE T DATE RECEIVED -SHORELINE CONDITIONAL USE The Washington State Shoreline Management Act(RCW 90.58) requires that substantial developments within designated shorelines of the state comply with its administrative procedures (WAC 173-14) and the provisions of the Mason County Shoreline Management Master Program. The purpose of this Act and local program is to protect the state's shoreline resources. The program requires that substantial development an development f P (any o which the total cost r P o fair market value exceeds $5,000 or materially interferes with the normal public use of the water or shorelines of the State) be reviewed with the goals, policies, and performance standards established in the Master Program. Answer all questions completely. Attach any additional information that may further describe the proposed development. Incomplete applications will be returned. APPLICANT: t�l ADDRESS: w N, F— M*<,,si J C-it.e,L (Street) r (City) (State) (Zip) TELEPHONE: (Home): r 7J � j (Business): AUTHORIZED ._ REPRESENTATIVE: ADDRESS: �• d, �x �� U (Street) (City) State) (Zip) TELEPHONE: (Home): (Business): 2 7�- (p c� PROPERTY DESCRIPTION General Location (include property address, water body and associated wed nds--identify the name of the shoreline): ?/ , _ C f ,Q,1 Kam{• 1f�� Legal Description (include section, township, and range to the nearest quarter, quarter section or latitude and longitude to the nearest minute. Projects located in open water areas away from land shall provide a longitude location): Include all parcel numbers. OWNERSHIP Contract Applicant Owner Lessee Purchaser (Identify) Other_ Owner: c &11%-1 GZ Q�� l 1 T (Street) (City) (State) (Zip) (Revised 6/02) i The Shoreline Permit Application Page 2 1 DEVELOPMENT DESCRIPTION Development(identify and describe the proposed project, including the type of materials to be used, , constructions mmethods, principal dimensions, and other pertinent information): 9 1 P 1`n kp �VGI QA o `1 A rJ to G�— V— 2)'"A a'i 0 m X r X e0o f Use (iden 'fy current use �of^property with existing improvements and structures: , Vicinity (identify ADJACENT uses, s ctures and improvements, intensity of devleopment and physical characteristics): Reason for requesting development: Tf XP.A i C I ow ACKNOWLEDGEMENT I hereby declare, to the best of my knowledge and belief, the foregoing information and all attached informaq*gWis true aj1d corre t;& - v2-4 (A licant or Authorized Representative) (Date) ------------------------------------------------------------------------------------------------------------------------------- TO BE COMPLETED BY LOCAL OFFICIAL Identify and describe existing features of the site and surrounding area. If proposed structures will exceed a height of 35 feet above the existing grade level, indicate the location of any residential units that will have an obstructed view. If a Conditional Use or Variance is requested, make reference to the appropriate section in the Master Program. (Revised 5/97) THE SHORELINE PERMIT PROCESS Page 5 t Publication cost is the responsibility of the applicant. Final permit processing will = 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. 7— �-02-- 04 ER APPLICANT Revised 3/01 i . The Shoreline Permit Application Page 3 PERMIT NO. ADJACENT PROPERTY OWNERS LIST Addresses are to be obtained from the Mason County Assessor's Office, Building I, Second Floor. (Revised 1/95) I a JARPA FORM Ow use In WasMnptan State) PLEASE TYPE OR PRim N'I.BLUE OR BLACK INK ��i i.w•°ti 7ashington Preceding checldist,1 am sending copies of this application to the following: (check aN that apply) al Government for shoreline: ❑Substantial Development ❑Conditional Use ❑Variance ❑ Exemption;or,if applicable ❑ Floodplaln Management ❑Critical Areas Ordinance shington Department of Fish and Wildlife for HPA el.-W,aashington Department of Ecology for: ❑Approval to Allow Temporary Exceedance of Water Quality Standards ❑401 Water Quality Certification Nationwide Permits Department of Natural Resources for.❑Aquatic Resources Use Authorization Notification iUJOr Corps Engineers for:El Section 4o4 ❑Section 10 permit ❑ Coast Guard for ❑Section 9 Bridge Permit SECT/ON A -Use for all permits covered by this application. Be sure to also complete Section C(Signature Block)for all permit applications. 1.APPLICANT 11NN �n MAILING ADDRESS WORK PHONE 5Y 9 V HOME PHONE T AX/{ �Qy-..� 'an agent is acting for the applicant during the permit process,complete#2. 2.AUTHORIZED ENT 0 1141 I-Ira1a 1 . MAILING ADDRESS WORK PHONE HOME PHONE R # 1.RELATIONSHIP OF APPLICANT TO PROPERTY: OWNER ❑PURCHASER ❑LESSEE ❑OTHER: 1.NAME,ADDRESS,AND PHONE NUMBER OF PROPERTY OWNER(S),IF OTHER THAN APPL ICANT LOCATION(STREET ADDRESS,INCLUDING CITY COUNTY AND ZIP CODE WHER E PROPOSED ACTIVITY EXISTS OR WILL OCCUR) GIN"e- aS 'ATERBOOY TRIBUTARY OF /SECTION TO RANGE GOVERNMENT LOT SHORELINE DESIGNATION (`n i SS l a tJ �;e�� ZONING DESIGNATION K PARCEL NO:a � 3 S� dyovg ONR STREAM TYPE,IF KNOWN� s Appq"t,on Page 1 of 4 i PROPOW. " 0F'*EPRoP�TM AND 6nWCn4wm8 s woORTWPROPISIM FARYPORnoNOF,►,E MMM AM VEAR OF 69A E PROP05®ACIMTY IS,1l RE„DY (z i QQ11J Ce'.. LSO" eS THE PROPERTY AGRICULTURAL LAND?❑YES NO 741. DESCRIBE THE PROPOSED WORK COMPLETE PLANS AND fa\ v �� SPECIFICATIONS SHOULD BE PRO ARE YOU A USDA PROGRAM PARTIGPANT7 O YES VIDED FOR ALL WORK WATERWARD OF THE ORDINARY HIGH WATER MARK OR P ' `a e� go )e+ 0 �� w �'� �va�-iy �tit-�C� �P'v��,.Ia,�s a►�� 1re�.�o lb.DESCRIBE THE PURPOSE OF.THE PROPOSED WORK To fo feq,IN)tN 2c DESCRIBE THE POTENTIAL IMPACT RECREATION. S TO CHARACTERISTIC USES OF THE WATER BODY. THESE USES MAY INCLUDE FISH AND AQUATIC LIFE,WATER QUALITY,WATER �a p �� ' IDENTIFY PROPOSED1 CTTONS TO AV D.MINIMIZE,AND MITIGATE DETRIMENTAL MPACT AND PROVIDE PROPER PROTECTION IDI PREPARATION OF DRAWINGS: SEE APPENDIX A-SAMPLE DRAWINGS AND CHECKLIST FOR COMPLETING THE DRAWINGS. ONE SET OF ORIGINAL OR GOOD QUALITY REpR00f/CJ6LEORAW/A/GSrBE ATTACHED, NOTE APPLICANTS ARE ENCOURAGED TO SUBMIT PHOTOGRAPHS OF THE PROJECT SITE,BUT THESE DO NOT SUBSTITUTE FOR LRAWINGS. THE CORpS OF EAIGINEERS AND COAST GUARD REQUIRE DRAWINGS ON d-1/1 X 1 f/NCH SHEETS, LARGER DRAWINGS MAYBE REQUIRED BY OTHER AO&VCIES E.WILL THE PROJECT BE CON STRUCTED IN STAGES? PROPOSED STARTING DATE: 0 YES �NO ESTMMTEO DURATKXr OF ACTIVITY: 0.CHECK IF ANY STRUCTURES WILL BE PLACED: ATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE FOR FRESH OR TIDAL WATERS,AND/OR [[❑WATERWARD OF THE MEAN HIGH WATER LINE IN TIDAL WATERS 10.WILL FILL MATERIAL(ROCK FILL,BULKHEAD PILINGS OR OTHER MATERIAL)BE PLACED: (/ ?kWATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE FOR FRESH WATERS? 7 O WATERWARO OF THE MEAN HIGHER HIGH WATER FOR TIDAL WATERS? IF YES.VOLUME(CUBIC YARDS) /AREA (ACRES 11.WILL MATERIAL BE PLACED IN WETLANDS? IF YES,VOLUME(CUBIC YARDS) /AREA (ACRES) IF YES: AYES ❑NO A.IMPACTED AREA IN ACRES: B.HAS A DELINEATION BEEN COMPLETED? IF YES,PLEASE SUBMIT WITH APPLICATION - C.HAS A WETLAND REPORT BEEN PREPARED? IF YES ❑YES Cl NO PLEASE SUBMIT WITH APPLICATION O.TYPE AND COMPOSITION OF FILL MATERIAL O YES ONO (E.G.,SAND,ETC.): E.MATERIAL SOURCE: Qtjo r i ekr-ir'— F.LIST ALL SOIL SERIES(TYPE OF SOIL)LOCATED AT THE PROJECT XTAMED FROM THE NATUFTAL RESOURCES CONSERVATION SERVICE MJOICATE IF THEY ARE ON THE COl1NTYS LIST OF HYDRK SOILS. SOILS INFORMATION CAN BE SITE 12 WILL PROPOSED ACTIVITY CAUSE FLOODING OR DRAB OF uu ❑YES LINO .. APJW`Kation Page 2 of 4 I S&W XL O(CAVATION OR DPJ330M BE RECAAR®N WATER OR WETLANDS? �YES ONO Fvm A.VOLUME—_PUENC YARDSYAREA__(ACRES) S.COMPOSITION OF MATERIAL TO BE REMOVED: K t'J'Ar C.DISPOSAL sITE FOR EXCAVATED MATERIAL: D.METHOD OF DREDGING: c w U.LIST OTHER APPLICATIONS,APPROVALS.OR CERTIFICATIONS FROM OTHER FE)ERAL,STATE OR LOCAL AGENCIES FOR ANY STRUCTURES,CONSTRUCTM.DISCHARGES, OR OTHER ACTIVITIES DESCRIBED N 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 APPROVAL FOR THE ACTIVITY DESCRIBED HEREIN OR FOR ANY ACTIVITY DIRECTLY RELATED TO THE ACTIVITY DESCRIBED HEREIN?❑YES ANO IF YES,EXPLAIN: - SECTION B-Use for Shoreline and Corps of Engineers permits only: 16. TOTAL COST OF PROJECT. THIS MEANS THE FAIR MARKET VALI j�OF THE PROJECT,INCLUDING MATERIALS,LABOR,MACHINE RENTALS,ETC. )({ 17. LOCAL GOVERNMENT WITH JURISDICTION: 16. 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 REOIMRE ADDITIONAL NOTICE-CONSULT YOUR LOCAL GOVERNMENT. NAME ADDRESS PHONE NUMBER Apply t*n Pape 3 of 4 SEICMN C-This section MUST be con1pieted W&ny PeMW covered by ttas appacatkxL - . -i IS- APPLICATION IS HEReErf MADE FOR A PERma OR pERMITS To AUTI40RIZE THE ACTMTIES DESCROED WORMATION OONTA04ED IN HEREK I ACCURATE. I R.IRTHER THIS APPLICATIOR AND THAT TO THE BEST OF My KNOVAEDGE CERTIFY THAT I AM FAMILIAR VWM THE AND BELIEF,SUCH INFORMATION IS TRUF_ CERTIFY THAT I POSSESS THE AunlORITY TO UNDERTAKE THE PROPOSM ACTNMES. I M;NMY GRANT TO THE AGENCIES To V""K34 TI"APPLICATION IS MADF—TW RK*ff To ENTER THE AgOVE4)E� COMMEM AND VORK I TO START WORK BED LOCATION TO INSPECT THE PROPOSED IN ALL W<ESWY PERMfTS RAVE BEEN RECEWED -PROGRESS OR COmKETED OF APPLICANT OR AUT114ORoW DAM 1 HSUMY DEMNATE Ei a TO ACT AS My ENT IN M S RELATED T THIS APPLICATION FOR PERmrr(s). I UNDERSTAND THAT IF A FEDERAL pERMrr ISSUED.I U N PERMIT IS M S'T S-1—G THE Sr-4A RE OF APPLICANT Flt'44J / - 2 -,-�--oz wkTE SIG"ATnUAR OF NDOWNER(EXCEPT PUBLIC ENTITY LANDOWNERS.E.G.ONR) W. DATE THIS TDKM)N MUST BE NED BY THE CANT AND THE AGENT-IF AN Al WaMwNa — IF AN Aln— IS DESIGNATED. 18 U-S-C§1001 provides ftt Whoever.in any man %in is fd@vlo@ a material fad Of makes any false.ficlibou'.ne'*tli the J"r diction of any department or agency o(V*United States kno%ingly faisirses raudulent Guternent or entry. o'fraudulent statements of repre"ritations of makes or conceals,Of Covers up by any bick scheme o, ned not mom than$10-000 of kr�not more than 5 years or both us"any false wftng or docurnent'knowing same-to contain any false.fixttious:of $hatl be fi �W.. VTOV .. ........ .. ............ ........... latn,-�� 50 61 6:1 V.K� ... ........... ... ......... ..... ............ ..... ....... .. ........ . ...... .. ........ ... ............. .. ....... A. fv6 W tE .... ...... ......... .......... ........... .0—whO . ..... ....... ....... ........ 0 V:' . ............... ............ in. MOM wmffiwiva .. ......... ......... 1ft �Jedtad ............ ............. .......... 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