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Home My WebLink AboutSHX2004-00050 JARPA - SHX Permit / Conditions - 1/4/2005 oN-STATE MASON COUNTY c ° DEPARTMENT OF COMMUNITY DEVELOPMENT o A N Planning Division o N = P 0 Box 279, Shelton, WA 98584 N y o (360)427-9670 Y OJ �O 1864 Exemption from Shoreline Management Act Case No.: SHX2004-00050 Substantial Development Permit Requirement The Proposal By: DONALD CARLYLE 10901 176TH CIRCLE NE#206C REDMOND,WA 98052 To undertake the following development: Replace an unsafe dock and replace it with a 432 sq. ft. dock - both are pier, ramp and float docks. The new dock is smaller in size (i.e. footprint) than the existing rotten one. Within MASON LAKE and/or its associated wetlands is exempt from the requirement of substantial development because the development is categorized under WAC 173-1-040(B) as being category B-normal maintenance Please contact Charles Mead McCoy III at ext 294 if you have any questions. 1 Issued: 1/4/2005 � V Expires: 1/4/2006 Authorized Local Government Official cc: APPLICANT WDFW -GLOPA l WDOE TRIBAL COUNCIL — SQVAX►P.t AGENCY USE ONLY Agency Reference#: Date Received: Circulated by: (local govt.or agency) JOINT AQUATIC RESOURCES PERMIT APPLICATION FORM (DARPA) (for use in Washington State) PLEASE TYPE OR PRINT IN BLACK INK a ❑ I am applying for a Fish Habitat Enhancement Project per requirements of RCW 75.20.350. You must submit a copy of this completed JARPA application form, and the (Fish Habitat Enhancement JARPA 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 day Based 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 ® Exemption ❑ Revision ❑ Floociplain 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 Nationwide Permits(to Regional office-Federal Permit Unit) ❑ Washington Department of Natural Resources for Aquatic Resources Use Authorization Notification ❑ -Corps of Engineers for: ❑Section 404 ❑Section 10 permit ❑ Coast Guard for Section 9 Bridge Permit ❑ US Fish&.Wildlife Service or National Marine Fisheries Service for Endangered Species Act(ESA)Consultation 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 I e� MAILING ADDRESS WORK PHONE E-MAIL ADDRESS HOME PHONE FAX M If an agent is acting for the applicant during the permit process,complete t12. 2.AUTHORIZED G NT w 7'- ` C zST�uGT�o�� MAILING ADDRESS 4-F -VA-e�4 n i(JA ZZ Z. t4i 41- WORK PHONE EMAIL ADDRESS kAP� OME PHONE FAIL c 3 1/ /2-Q;Z03 3.RELATIONSHIP OF APPLICANT TO PROPERTY: OWNER t]PURCHASER ❑LESSEE ❑OTHER: 4.NAME,ADDRESS,AND PHONE NUMBER OF PROPERTY ONNER(S),IF OTHER THAN APPLICANT: 0 LAI< E- 30L)7 4 — 6 IJl eel 5.LOCATION(STREET ADDRESS,INC�LUpG�ITY,COUNTY AND ZIP CODE,WHERE PROPOSED ACTIVITY EXISTS OR WILL OCCUR) l-f -3 - - RZT->l Lr- T S i T ,U As of kl'. 30 U T-tf- LOCAL GOVERNMENT WITH JURISDICTION(CITY OR COUNTY) WATERBODY TRIBUTARY OF IA X SECTION SECTION I TOWNSHIP I RANGE I GOVERNMENT LOT SHORELINE DESIGNATION LATITUDE&LONGITUDE ZONING DESIGNATION IF KNOWN: TAX PARCEL NO: ONR STREAM TYPE,IF KNOWN 2. TARPA Revised 12/98. contact Ecolo¢v's Permit Assistance Center for latest version, 360/407-7037 Page 1 of 4 6.DESCRIBE THE CURRENT USE OF THE PROPERTY,AND STRUCTURES EXISTING ON THE PROPERTY. IF ANY PORTION OF THE PROPOSED ACTIVITY IS ALREADY COMPLETED ON THIS PROPERTY,INDICATE MONTH AND YEAR OF COMPLETION. IS THE PROPERTY AGRICULTURAL LAND? ❑YES NO ARE YOU A USDA PR OGRAM PARTICIPANT? ❑YES NO 7a. DESCRIBE THE PROPOSED CONSTRUCTION AND/OR FILL WORK FOR THE PROJECT THAT YOU WANT TO BUILD THAT NEEDS AQUATIC PERMITS: COMPLETE PLANS AND SPECIFICATIONS SHOULD BE PROVIDED FOR ALL WORK WATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE,INCLUDING TYPES OF EQUIPMENT TO BE USED. IF APPLYING FOR A SHORELINE PERMIT,DESCRIBE ALL WORK WITHIN AND BEYOND 200 FEET OF THE ORDINARY HIGH WATER MARK ATTACH A SEPARATE SHEET IF ADDITIONAL SPACE IS NEEDED. �z I will !lz /C) 7b. DESCRIBE THE PURPOSE OF THE PROPOSED WORK AND WHY YOU WANT OR NEED TO PERFORM IT AT THE SITE. PLEASE EXPLAIN ANY SPECIFIC NEEDS THAT HAVE INFLUENCED THE DESIGN. 7c. DESCRIBE THE POTENTIAL IMPACTS TO CHARACTERISTIC USES OF THE WATER BODY, THESE USES MAY INCLUDE FISH AND AQUATIC LIFE.WATER QUALITY,WATER SUPPLY, RECREATION,and AESTHETICS. IDENTIFY PROPOSED ACTIONS TO AVOID,MINIMIZE,AND MITIGATE DETRIMENTAL IMPACTS,AND PROVIDE PROPER PROTECTION OF FISH AND AQUATIC LIFE. ATTACH A SEPARATE SHEET IF ADDITIONAL SPACE IS NEEDED. PREPARATION OF DRAWINGS: SEE SAMPLE DRAWINGS AND GUIDANCE FOR COMPLETING THE DRAWINGS. ONE SET OF ORIGINAL OR GOOD QUALITY REPRODUCIBLE DRAWINGS MUST BE ATTACHED. NOTE: APPLICANTS ARE ENCOURAGED TO SUBMIT PHOTOGRAPHS OF THE PROJECT SITE,BUT THESE DO NOT SUBSTITUTE FOR DRAWINGS. THE CORPS OF ENGINEERS AND COASTGUARD REQUIRE DRAWINGS ON 8-112 X 11 INCH SHEETS. LARGER DRAWINGS MAY BE REQUIRED BY OTHER AGENCIES. 8,WILL THE PROJECT BE CONSTRUCTED IN STAGES? /��J ❑YES ❑ PROPOSED STARTING DATE: f, -- 1'..QiC.t_ tit i(J A ESTIMATED DURATION OF ACTIVITY: r7— `0 I V J 9.`CCHECK IF ANY STRUCTURES WILL BE PLACED: p WATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE FOR FRESH OR TIDAL WATERS,AND/OR /❑WATERWARD OF MEAN HIGH WATER LINE IN TIDAL WATERS 10.WILL FILL MATERIAL(ROCK FILL,BULKHEAD,OR OTHER MATERIAL)BE PLACED: /1 ❑WATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE FOR FRESH WATERS? V IF YES,VOLUME(CUBIC YARDS) /AREA (ACRES) ❑WATERWARD OF THE MEAN HIGHER HIGH WATER FOR TIDAL WATERS? IF YES,VOLUME(CUBIC YARDS) AREA (ACRES) fARPA_ Revised 12/98_ contact Ecolo¢v's Permit Assistance Center fnr btecr vercion 'A60/407-7017 13— ') -f e 11 WILL MATERIAL BE PLACED IN WETLANDS? ❑YES NO 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 LIST OF HYDRIC SOILS.SOILS INFORMATION CAN BE OBTAINED FROM THE NATURAL RESOURCES CONSERVATION SERVICE(NRCS): 12.WKL PROPOSED ACTIVITY CAUSE FLOODING OR DRAINING OF WETLANDS? ❑YES p gyp IF YES,IMPACTED AREA IS ACRES. 13.WILL EXCAVATION OR DREDGING BE REQUIRED IN WATER OR WETLANDS? ❑YES 0 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 ENVIRONMENTAL POLICY ACT(SEPA)BEEN COMPLETED? p YES ❑NO SEPA LEAD AGENCY: SEPA DECISION: DNS,MONS,EIS,ADOPTION,EXEMPTION DECISION DATE(END OF PERIOD): SUBMIT A COPY OF YOUR SEPA DECISION LETTER TO WDFW 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 COMMISSION LICENSE(FERC),FOREST PRACTICES APPLICATION,ETC.) ALSO INDICATE WHETHER WORK HAS BEEN COMPLETED AND INDICATE ALL EXISTING WORK ON DRAWINGS. TYPE OF APPROVAL ISSUING AGENCY IDENTIFICATION DATE OF APPLICATION DATE APPROVED COMPLETED? NO. lex �Lcr r 16.HAS ANY AGENCYpp,IED APPROVAL FOR THE ACTIVITY DESCRIBED HEREIN OR F R ANY ACTIVITY DIRECTLY RELATED TO THE ACTIVITY DESCRIBED HEREIN? ❑YES NO IF YES,EXPLAIN: SECTION B-Use for Shoreline and Corps of Engineers permits onl 17.TOTAL COST OF PROJECT. THIS MEANS THE FAIR MARKET VALUE OF THE PROJECT,INCLUDING MATERIALS,LABOR,MACHINE RENTALS.ETC. �3� S 18.LOCAL GOVERNMENT WITH JURISDICTI 19.FOR CORPS,COAST GUARD,AND ONR PERMITS,PROVIDE NAMES,ADDRESSES,AND TELEPHWk NUMBERS OF ADJOINING PROPERTY OWNERS,LESSEES,ETC.. PLEASE NOTE: SHORELINE MANAGEMENT COMPLIANCE MAY REQUIRE ADDITIONAL NOTICE—CONSULT YOUR LOCAL GOVERNMENT. NAME ADDRESS PHONE NUMBER SUCTION C- This section MUST be completed for any permit covered by this 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 THAT TO 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 TO START WORK ONLY AFTER ALL NECESSARY PERMITS HAVE BEEN RECEIVED. SIGNATURE OF APPLIC OR VTHORIZEO AGENT ATE I HEREBY DESIGNATE ' `^y , 5f Tvd7el-`, TO ACT AS MY AGENT IN MATTE IZJJF TF!n_2FTHIS APPLICATION FOR PERMIT(S). I UNDERSTAND THAT IF A FEDERAL PERMIT IS ISSUED, S N THE PERMIT. �y �l `(Ll 00 SIGNATURE OF APPLICANT DATE SIGNATURE LANDOWNER(EXCEPT PUBLIC ENTITY -� LANDOWNERS,E.G.DNR) ATE oU THIS APPLICATION MUST BE SIGNED BY THE APPLICANT AND T44 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 coven up by any trick,scheme,or device a material tact or makes any false,fictitious,or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false,fictitious,or fraudulent statement or entry,shall be fined not more than s10,000 or imprisoned not more than 5 years or both. COMPLETED BY LOCAL OFFICIAL A. Nature of the existing shoreline. (Describe type of shoreline, such as marine, stream, lake, lagoon, marsh, bog, swamp,flood plain,floodway, delta;type of beach,such as accretion,erosion, high bank, low bank, or dike; material such as sand, gravel, mud, Gay, rock, riprap;and extent and type of bulkheading, if any:) B. In the event that any of the proposed buildings or structures will exceed a height of thirty-five feet above the average grade level, indicate the approximate location of and number of residential units,existing and potential,that will have an obstructed view: C. If the application involves a conditional use or variance, set forth in full that portion of the master program which provides that the proposed use may be a conditional use, or, in the case of a variance,from which the variance is being 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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