HomeMy WebLinkAboutMEP2005-00015 - MEP Permit / Conditions - 2/3/2005 PERMIT NO.: � O
ED —
- MASON COUNTY DATE RECEIV
DEPARTMENT OF COMMUNITY DEVELOPMENT RECEIVED
RESOURCE ORDINANCE (Chapter 17.01 MCC) FEB 0 3 2005
411 N.5TH Street/P.O. Box 279,Shelton, WA 985"
dELFAIR OFFICE
ENVIRONMENTAL PERMIT APPLICATION
MASON ENVIRONMENTAL PERMIT 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.
Owner: fl L_ Owner Mailing Address:
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Site Address:
/DaZ A/I, L.AK`L.,Di21 V£- City: %li G a 1-1 4 State! 4 Zip:Wg�
City:7A/I/%q Stag-& _Zip'& Aien/Title Holder
SAW
Phone: Daytime03 ) �,23�'vz 00`r
Address:
Fire District#:
City: State: Zip:
Signatur
2. Parcel Number:2-a33 Q _ .Sd _ a 0/6 7 Legal description: Lat /6'7
Parcel Size: o21 S/D so �/�//�
3. Directions to site:
N u/'1 3 10 11AA.Aj 6 C) L-g I-Ak J- > E 5 ilk /Q vX6 —
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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 ❑
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Identify current use of property with existing improvements: 0p
1� (Z4MIOua &A-riAn ;5wtoA^1L/
6.
Identify and describe the proposed project,including the type of materials to be used,construction methods,principle
dimensions and other pertinent information(Attach additional sheets if
needed): A5-P1-AN xJG r)IJ) C12C-K Well &UQ - 6 ')( 3y AIAJeWAy ro 1�.k' ff
PLA'IFo2vv PIUAl65 - T-4-Mlfb 1-00^614 -r AiQ.v-Wyd4 CO&%eastfz
7. Will there bean alteration of a wetland and/or wetland vegetation area? Yes ❑ No A
8. Any water on or adjacent to property:
Saltwater 0 Lake l9( River ❑ Pond ❑ Wetland ❑ Seasonal Runoff 0
Other
9. If sep 'c is located on project site,include records.
A Connect to septic? 0 Community Septic? ❑ Public Water Supply? ❑ Well? ❑
10.
Type of Job: New Add ❑ Alt ❑ Repair ❑ Demolition ❑ Other
This permit is granted pursuant to the 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 thisproject, but not inconsistent with the Resource,Ordinance. Thepermit 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
I
r.
Show the following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Water Lines Driveways
Drainage Plans Shorelines
Septic System Topography Indicate Directional by(N,S,E,W,etc.)
Proposed Improvements Easements In relation to plot plan
Name if Flanking Street
APPLICANT TO DRAW SITE PLAN BELOW:
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APPLICANT TO DRAW TOPOGRAPHY BELOW:
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DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
COMMENTS
Planning:
Environmental
Health:
Building Plan
Review:
Occupancy
Group:
Fire Marshal:
Other:
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Conditions: FEES
Total fees:
Accepted by: Date:
MASON COUNTY RESOURCE 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.
/-31- 05
DATE
OWNER
APPLICANT
A
MASON COUNTY RESOURCE ORDINANCE July 2W3
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.