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Home My WebLink AboutSHX2005-00012 JARPA - SHX Permit / Conditions - 3/10/2005 PCOON.STgTFO� MASON COUNTY C DEPARTMENT OF COMMUNITY DEVELOPMENT o n o �N Planning Division r p N = P O Box 279, Shelton,WA 98584 x� N Y ti (360)427-9670 0 0 u 1a64 Exemption from Shoreline Management Act Case No.: SHX2005-00012 Substantial Development Permit Requirement The Proposal By: LAKESHORE CONSTRUCTION P.O.BOX 1058 BELFAIR,WA 998528 To undertake the following development: Dock replacement. Within HAVEN 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. Issued: 3/10/2005 ��- Expires: 3/10/2006 Authorized Local Government Official ,per e�TM- cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL _ Skokow�S{} LAKE DRIVE I (420.25) (50.00) - _- _S 3430'00" W `--- -- — (50.00) F496 (50.00) \ 49.85 (.50.0�)/ (50 00) — v m n 100 09 � 149 O0 41 �'`rvo�`G� O Y U ZO�.�� ' 01 D � r U c� f' N r � N <n C7 OD TJ ;- �✓� o U 0 z�o� mil. 2p O `P Al CID n L � S N FP� ro A 01 '�o o ip o �• p G `\L C 0 � ao o k Mq 004 nnN OF N�GN WA RECEIVED FEB 0 3 2005 3ELFAIR OFFICE AGENCY USE ONLY Agency Reference#: Date Received:_ Circulated by: (local govt.or agency) JOINT AQUATIC RESOURCES PERMIT APPLICATION FORM (JARPA) (for use in Washington State) PLEASE TYPE OR PRINT IN BLACK INK � �ZOUS�c`�12 ❑ I am applying for a Fish Habitat Enhancement Project per requirements of RCW 75.20.350. You must submit a copy inor PA of this completed JARPA application form, and the(Fish Habitat Enhancement JAR 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 Based on the instructions provided, I am sending copies of this application to the following: (check all that apply) ❑ Local Government for shoreline:El Substantial Development ❑Conditional Use ❑Variance jzxemption ❑ 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 Nationwide Permits(to Regional office-Federal Permit Unit) ❑ Washington Department of Natural Resources for Aquatic Resources Use Authorization Notification RECEIVED [ICorps of Engineers for: ❑ Section 404 ❑Section 10 permit ❑ Coast Guard for Section 9 Bridge Permit CC ElUS Fish&Wildlife Service or National Marine Fisheries Service for Endangered Species Act(ESA)ConsultatiDfiEB 0 3 2005 SELFA n [ SECTION A-Use for all permits covered by this application. Be sure to ALSO complete Section C(Signature Block)for NpPfi t ;glications. 1.APPLICANT MAILING ADDRESS ,� cr ,l f Yx l 4_6 WORK PHONE E-MAIL ADDRESS HOME PH NE FAX# ,3 • -5. 3Yb't. If an agent is acting for the applicant during the permit process,complete#2. 2.AUTHORIZED AG�r+T i LOr-C l l-><1 c� MAILING ADDRESS ORK PHHOONE� E-MAIL ADDRESS HOME PHONE FAX# 3.RELATIONSHIP OF APPLICANT TO PROPERTY: WNER ❑PURCHASER ❑LESSEE ❑OTHER: 4.NAME,ADDRESS,AND PHONE NUMBER OF PROPERTY OWNER(S),IF OTHER THAN APPLICANT: I 5.LOCATION(STREET ADDRESS,INCLUDING CITY,COUNTY AND ZIP CODE,WHERE PROPOSED ACTIVITY EXISTS OR WILL OCCUR) LOCAL GOVERNMENT WITH JURISDICTION(CITY OR COU TY) _. WATER00gq(/4� / TRIBUTA�YOF C4� WRwa SECTION VWISECTIONWNSHIP RANGE GOVERNMENT LOT SHOOPAREELL``IN..E�w.•.-l1IIjjSIGNATION 2 r LATITUDE&LONGITUDE ZONING DESIGNATION IF KNOWN: n tI TAX PARCEL NO: DNR STREAM TYPE,IF KNOWN - 223 t0/�,7 JARPA,Revised 12/98,contact Ecology's Permit Assistance Center for latest version,360/407-7037 Page 1 of 4 .DESCRIBE THE CURRENT USE OF THE PROPERTY.AND STRUCTURES EXISTING ON THE PROPERTY. IF ANY PORTION OF THE PROPOSED ACTIVITY IS ALREADY COMPLETED ON HIS PROPERTY,INDICATE MONTH AND YEAR OF COMPLETION. IS THE PROPERTY AGRICULTURAL LAND? ❑YES ARE YOU A USDA PROGRAM PARTICIPANT? O YES POO 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 6U WORK WITHIN AND BEYOND 200 FEET OF THE ORDINARY HIGH WATER MARK. ATTACH A SEPARATE SHEET IF ADDITIONAL SPACE IS NEED PrI 7D. 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. /L/Gh C PREPARATION OF DRAWINGS: SEE SAMPLE DRAWINGS AND GUIDANCE FOR COMPLETING THE DRAWINGS, ONE SET OF ORIGINAL OR GOOD QUALITYREPRODUCIBLE DRAWINGS MUST BEATTACHED. NOTE: APPLICANTS ARE ENCOURAAL'C TO SUBMIT PHOTOGRAPHS OF THE PROJECT SITE,BUT THESE DO NOT SUBSTITUTE FOR DRAWINGS. THE CORPS OF ENGINEERS AND COAST GUARD REQUIRE DRAWINGS ON 8-1R X 11 INCH SHEETS. LARGER DRAWINGS MAYBE REQUIRED BY OTHER AGENCIES. B.WILL THE PROJECT BE CONSTRUCTED IN STAGES? ❑YES )"o PROPOSED STARTING DATE: 0M +,rAk-- I"IgOS' ESTIMATED DURATION OF ACTIVITY: 1;)601 .C✓✓✓HECK IF ANY STRUCTURES WILL BE PLACED:: . NATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE FOR FRESH OR TIDAL WATERS:AND/OR OWATERWARD OF MEAN HIGH WATER LINE IN TIDAL WATERS 10.WILL FILL MATERIAL(ROCK,FILL,BULKHEAD,OR OTHER MATERIAL)BE PLACED: /V 0 ❑WATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE FOR FRESH WATERS? IF YES,VOLUME(CUBIC YARDS) ZAREA (ACRES) ❑WATERWARD OF THE MEAN HIGHER HIGH WATER FOR TIDAL WATERS? IF YES,VOLUME(CUBIC YARDS) AREA (ACRES) DARPA,Revised 17/98,contact Ecology's Permit Assistance Center for latest version,360/407-7037 Page 2 of 4 11.WILL MATERIAL BE PLACED IN WETLANDS? d YES pAo IF YES: A. IMPACTED AREA IN ACRES: B. HAS A DELINEATION BEEN COMPLETED? IF YES,PLEASE SUBMIT WITH APPLICATION. 13 YES )&NO C. HAS A WETLAND REPORT BEEN PREPARED? IF YES,PLEASE SUBMIT WITH APPLICATION. O YES OCRO 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,3 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.WILL PROPOSED ACTIVITY CAUSE FLOODING OR DRAINING OF WETLANDS? ❑YES )ONO IF YES,IMPACTED AREA IS_ACRES. 13.WILL EXCAVATION OR DREDGING BE REQUIRED IN WATER OR WETLANDS? ❑YES 'wpo 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? ES ❑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. 2 0 3'- dr 16.HAS ANY AGENCY DENIED APPROVAL FOR THE ACTIVITY DESCRIBED HEREIN OR FOR ANY ACTIVITY DIRECTLY RELATED TO THE ACTIVITY DESCRIBED HEREIN? ❑YES 1p0 IF YES,EXPLAIN: SECTION B-Use for Shoreline and Corps of Engineers permits only: 17.TOTAL COST OF PROJECT. THIS MEANS THE FAIR-WRKET VALUE OF THE PROJECT,INCLUDING MATERIALS,LABOR,MACHINE RENTALS,ETC. 8.LOCAL GOVERNMENT WITH JURISDICTION: 9.FOR CORPS,COAST GUARD,AND DNR PERMITS,PROVIDE NAMES,ADDRESSES.AND TELEPHONE NUMBERS OF ADJOINING PROPERTY OWNERS,LESSEES.ETC.. PLEASE NOTE: SHORELINE MANAGEMENT COMPLLANCE MAY REQUIRE ADDITIONAL NOTICE-CONSULT YOUR LOCAL GOVERNMENT. NAME ADDRESS "' PHONE NUMBER DARPA,Revised 12/98,contact Ecology's Permit Assistance Center for latest version,360/407-7037 Page 3 of 4 SEC ON C-This section MUST be completed lbr any permit covered by this application APPLICATION IS HEREBY MADE FOR A PERMIT OR PERMITS TO AUTHORIZE THE ACTIVITIES DESCRIBED HEREIN. I CERTIFY THAT I AM FAMILIAR WITH THE NFORMATION 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 1 POSSESS THE AUTHORITY TO UNDERTAKE THE PROPOSED ACTIVITIES. I HEREBY GRANT TO THE AGENCIES TO WHICH IS 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 PL R AU RtZED AGENT M IHERE DESIG TE Zee-( TO ACT AS MY AGENT IN MATTERS RELATED TO THIS APPLICATION FOR PERMFT(S). 1 UNDERSTAND THAT IF A FEDERAL PERMIT IS ISSUED, 1 MUST SIGN THE PERMIT. SIGNATURE OF APPLICANT DATE r SIGNATURE OF LANDOWNER(EXCEPT PUBLIC ENTITY LANDOWNERS,E.G.DNR) TE I 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,scheme,or device a material fad 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,"tious,or fraudulent statement or entry,shall be fined not more than$10.000 or imprisoned not more than S years or both. GOYAPLETED 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,clay,rock,riprap;and extent and type of bulkhdading,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. JARPA,Revised 12/98,contact Ecology's Permit Assistance Center for latest version,360/407-7037 Page 4 of 4 i LAKE DRIVE (396.93) -- (420.25) \ (50.06) (50.00) 5 l34'30'050" W - ;� v�occJ`on 9 L�m.9a c.O7`�4•.o��0 v (ob� 49v�.8�6 oG.(50.00) y5O 0.00N) _ fI^ O� 00)10009 . 149 p\ C, 0 .-F (n y p O C y oA J�Ur A�d cJ p v G C� � N U CiCD !P L C a w 2c rri GN n v r� C+ 0 F � A r o `NL $• 9 � c9 \ �� 4PA n Ro r�MA or of 01GO � 1 i - RECEIVED FEB 0 3 2005 BELFAIR OFFICE i i r R f? JP l a , ape i ^ �35 5 un y W\ o N' / CV ►L c':, p� W o U m 'Q � � LL LW U „jA •� $ 5 dbJ -. e %IV way00, Bx 9 hAVII �( - sod 6ZOrrSu 890 t-8Zm VM 'ilails8 M xo8 'p 'd NOiionuiSNO3 3bOHS3x" �1 c