HomeMy WebLinkAboutPermit Miscellaneous 1996-6-25
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\ 'l~~ V\if ''::TLAND LAND USE NOTIFICATION Fl ' -"'", ,'-; j
~ ~.R V DIVISION OF STATE lANDS WETLANDS PROGRAM ' JJ~
\9-:1 ... , 775 Summer Street NE, Salem, Oregon 97310 (503/378-3805) &/)1" .
1 . 'County: L./!,ur . ,local Case File NO.:, () f~ P i~'1 ' L/
City: ,\;:J;(l/rJt;/~:jeL.O DSl File No.: f\ j
Responsib(e'Jurisdiction: '.0-- City [] County
2. APPLICANT: _5:"7J}ryte lANDOWNER: n/~A!J..,r l::'/J,itYf-ITS
, name name
-3 (.;, d:o.s- (~/Y1 /)"r/Z E E'K R c/
'I '
mailing address r:' mailing address o7unJ?
u;:J(2I;<JG-rI6't-O DiC / I/O
cHy state zip city state zip
( ) (07"/5' /,2 t. - :296 (;
phone phone
3.
LOCATION:
T /7 R O;L S J LI
NWI quad map name
Attached: ,NWI map
1/4 '7 t( Tax Lot(s) /00 Y
(attach copy with site indicated)
~ Parcel map /~ Site plan Other
4.
SITE INFORMATION:
NWI Wetland Classification Code(s)
Adjacent Waterway (if any)
Current land Use c/ /l c A7A I
In Flood P 1 a in? Y _ N _ , ,
Zoning /J:76?/tMt /)eM/'Y RB//J&111A("
5.
PROPOSED ACTIVITY:
site plan approval
grading permit
conditional use permit
other
Project Description:
subdivision
planned unit development
~ building permit (new structures)
'Ill.< ,jLe;/
, f
comPlete~ntact:, ,-511121111 'SUrJ'/r/'1c/ZS ' Date (;,//5'/7'("
Address ~ _~ 1r'L Sp(/tJ"'~/6-n I)/c 97 '1'77 Phone .-<<// 7.J(,'- 5/'bd
(This form isJto be co/:,pleted only by planning department' staff for mapped wetlands)
DSL RESPONSE
[] A removal-fill pe~mit is required from the Division of State Lands.
[] A removal-fill permit will be required when the development project proceeds.
[] A removal-fill permit may be required.
[] A permit may be requi red by the Corps of [ngi neers <326-6995)
[] Information needed includes:
(] A we t 1 and determi na t i on / de 1 i nea t i on report. (Consultant list available from DSL)
(]
[] State permit (] was issued (] has been applied for.
o No removal-fill permit is required for the described project if/because:
*
"
Comments:
Response completed by: Date
* If the project is changed to involve fill or removal from the wetlands area, a
state removal-fill permit will be required,