Application Original Info
RECE\P" No
5642
....rIVE HUNDRED rIr~Y DOJ,J,~RS & 00 CEN~S
DAlE
05 /15 / 91
REC NO
5642
AMOUN'
550.00
easel<
REF NO
1009
RECE\\IED FROM
YSLM pl\oeSSSHIG
MlseSLLANSOUS R~CSl1?T
BARB
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SI~E pJ,~N ENVIRO CHECK J,IS~
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CITY OF YELM
PO Box 479
Yelm WA 98597
360-458-3244
OFFICIAL USE ONLY
Fee
Date Received
By
APPLICATION FOR
Site Plan Review
File No.
Site Plan Fee.
Mobile Home Parks. $250 00 plus $50 00 per mobile home space
Multi-Family Building/Condominium $350.00 plus $50 00 per unit
Commercial Site Plan: $350 00 plus $50 00 per 1000 sq. ft of gross floor area
Industrial Site Plan. $35000 plus $150 per acre
(In addition, any professional service charges per Resolution #358)
Site plan review is a process for reviewing the design of certain types of development. Site plan
approval is required for mobile home parks, duplexes, multi-family dwellings, commercial and industrial
uses, planned development districts and for all land uses within the central business district.
NAME OF PROJECT Yelm Processinq Company
APPLICANT Fred Furgason
Mailing Address PO Box 532
City, State and Zip Yelm, WA 98597
Telephone 458-5342
OWNER Joe Sauve
Mailing Address 385 Humble Hill Road
City, State and Zip Sequim, WA 9838':<
Telephone (360) 681-6875
ENGINEER/ARCHITECT/OTHER SCA Engineerinq
Mailing Address PO Box 3485
City, State and Zip Lacey, WA 98509-3485
Telephone (360) 493 6002
.
SUMMARY OF REQUEST Reopen existinq dehydrator plant.
'",.,.
PROPERTYDESCRWnON
General Location NP Road North of Rhoton Road
Site Address 925 NP Road , Land Area (acres) 4.2
ac
Section 19 Township 17N Range 2F.
Assessor's Tax Parcel Number 64300900300
Full legal description of subject property (attach separate sheet if necessary)
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CITY OF YELM
ds\c:\office\plandept.cc\apps\spr.app
PAGE 1
PLEASE ANSWER THE FOLLOWING QUESTIONS
ATTACH EXTRA PAGES IF NECESSARY
1 Does the design minimize conflicts with neighboring land uses? Explain. No Surrounding
propert1es are 1nC1ustr1a.l
2. Is the site within 300 feet of any "critical areas" such as wetlands or streams? NO
3 What provisions will be made for storm water and/or flood control? Stormwater
facilities will be constructed.
4 What provisionl will ~e made for water s\JP'ply and sewage disposal? C it y Wa t e r
is avai ab e to the slfe and sewage lS handled w1th an
existinq drainfield
5 What provisions will be made for electrical power, natural gas, telephone and other utilities? All
utilities are currently provided.
6 What provisions will be made for streets, access, and/or buses? None
7 What provisions, if any, will be made for open space and/or recreation? None
8 What provisions will be made for schools and school children? None
I affirm that all answers, statements and information above and submitted with this application are complete and
accurate to the best of my knowledge. I also affirm that I am the owner of the subject site or am duly authorized
by the owner to act with respect to this application. Further, I grant permission from the owner to any and all
employees and representatives of the City of Yelm and other governmental agencies to enter upon and inspect
said property as reasonably necessary to process this application. I agree to pay all fees of the city which apply
to this application.
Signed ~-7~ Date 5- 14-9)
CITY OF YELM
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PAGE 2
SEC.
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SITE DA TA:
APPLICANT:
YELM PROCESSING CO
925 NORTHERN PACIFIC RD Sf.
YELM, WA 98597
(360) 458-8620
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VICINITY MAP
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JOB NUMBER:
YELM PROCESSING CO.
SITE PLAN
DRAW7NG NAME.
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I I REGISTRATIONS AND LICENSES
UNIFIED BUSINESS 10 #:
BUSINESS 10 #.
LOCATION.
600 583 121
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STATE 01:
WASHINGTON
ORGANIZATION TYPE
SOLE PROPRIETORSHIP
FREDERICK ARNOLD FERGUSON
YELM PROCESSING COMPANY
925 NORHTERN PACIFIC RD NW
YELM WA 98597
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TAX REGISTRATION
UNEMPLOYMENT INSURANCE
REGISTERED TRADE NAMES
FERGUSON BUILDERS
YELM PROCESSING COMPANY
INDUSTRIAL INSURANCE
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i. ~1 The above entity has been issued the business re9'.'strations or licenses listed ~\0 _ _ ~ . ;~'
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1997
CITY OF YELM
CLERK - TREASURER S OFFICE
BUSI
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FRED FERGUSON
IS HER=5Y UC~h:S== TO ,~.D=R~TE
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YELM PROCESSING COMPANY i
PO. BOX 532 I
YELM WA 98597 i
AT NP RD NW 925 )
This License must be posted in a LICENSE 97 - 003628 . 0
conspicuous place at the location. NUMBER
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TYPE OF LICENSE
I MANUFACTURING i
1997
LICENSING PERIOD JAN 1 19 97
OR FROM TO DEe 31 19 97
LICENSE NUMBER 97-003628.0
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I AMOUNT ~ I $ 1 0 . 0 0 1
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APPUC,tl.NT'S RECEIPT
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DENNIS COCHRAN, P B.
CIVIL ENGINEER
1709 93RD AVE BE
OLYMPIA, ~A. 98501
206-357-3073
May 29, 1990
CITY OF YELM
P.O. BOX 4?9
YELM. 1;lA 9859'1'
ATTN:
GENE BORGES
CITY ADXINSTRATOR
RE:
FERGUSON ENVIRONMENTAL CHECK LIST
GENE:
I discussed the prOject with Mr. Ferguson today so that I could under-
stand his process and better evaluate the Check List. His process (as
you already know) involves the drying and bulk packaging of brew~r's
yeast. This yeast is a by-pr-oduct of beer making ThE! mat.erial is
transported to the site in truck-tra11or vehicles in the jorm Df a wet
sludge. Mr. Ferguson atates that h@ expects two daliverl@s per w~ek.
When the product arrives it is Ware housed on sit. until it can be fed
into the dryer. After being dri~dl the yeast is packagad in bulk
containers, loaded onto eemis and hauled to Seattle for i~e-pack~ging
and distribution. Ferguson estimates two out-bound l'igs per we~k.
The~e are no customer services performed on site. All this is
a.ccomplished in Seattle. The sntire operation is run by Fred and on~
employee. There is no need for facilities :for petlple other than the
trucks, drivers, Fred and his employee. Any wash watar which ~ay be
generated must be disposed of in an acclIiptable manner to avoid
co:ntatnination of tha ground water, which in the Yel111 area is an un-
protected aquifer. There is no need for paving unless spills of 50me
sort are possible. In that case, paving and modified oil-water
separatore would be necessary. In this case I do not See tb1a aB a
glaring need. Ferguson indicated that his waste naterlal \~oul a~oUnt to
so~e two p~und6 per week. this coupled with the minimal amount of
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...-'I'lnce the:re is an emisaion of sorts t I called tbe OL YMP IC AIR POLLUr ION
CONTROL AUTHORITY tor theil' input. They are mdre conct;lrned about an
odor problem than air pollution. However, they dc have jur1Gdivt1on in
these 1Ilf\tt~ns and want Ferguson to go through their procel5~. Thay ana
also gQv~rn8d by the SBPA proces6 and have their own 30 day review
t~:we outside of the Check List review period. A telephone call to
586-0593 will begin the process. I explained to the fallow at Olympic
that the site was next door to Hytech and that any odor gunerated here
would need to be extremely powerful to oVercome that aroma. However,
he suggested that it is ~uch better to have Olympic invQlved from g1t-
go than to try to fight something thruagh later I agree with that.
The only other comments I can th;1.nk of are b~1ng sUI'S that the storm
water is prope~ly handled and that any fill material 18 both placed and
compacted properly. He should be careful about aiting his drainiield.
The County does %lot allow leaching 11ne5 1n fill othel~ than mounds.
Howev~r, this is not our concern
I hope 1 did not rock the boat too severely for Mr. Ferguson by c~111ng
the Air people. My pe~sonal feeling is that it 1s better to attempt to
gat these people involved at the beginning 1stead of trying to bluff
your way through and getting caught. Besides, I am doing this to keep
your chestnuts out of the fire.
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DENNIS COCHRANt P.E.
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STATE OF WASHINGTON
county of Thurston
L.te.1 M99t~ollC HOTICl
()~Y~PIC .Alll pOUltnON
t;;OHH10L AVnlOAITY
NOTICI! OF CONSTRUCTION
(hOC)
AND ..."PLICATION
tOA Al'f'AOvAL
NOC 11I211
V.lm r""oe,i"f (;o,hpon1
r O. Bo. 5J2
lelm, WA 'Hl597
Pur1ua,,1 tu ~""lIurl 7.01 Ie) of R.,u.
tallon I, nollee II hereby il,@ lhal he
Y.lrn rr<<e$~lrt~ Cur\1PMi ~Jl 1iI.~
.tMI~Q or Cq~,trI/Cll\ll1 .nd Applin-
lion for Applov.1 (Noel" 10 Install I
yeall dryll\~ 'dcllily a pyl.nlldl W'J(
,our.., .' 92~ N, P 11m N'V, \"1.lm
IrI\lV1111~' P~'~" Yorm,
PR~~IMIH^RY PLltRMINATlON'
Olympic All rullulion COntrol AulhO<lty
(uAf'tA) nu t.OO~lalod a plalllldoA')"
thlew and h.s .Ie"nlned 1I1al l/oe,
pru\l<.~ In1I.II.t on will n<ll .dvefiQly
~rl.',l Ilr qlJlhl( .nd meat1 III lhl
re<lwllclOen\~ 0 R.gvl.tlon I In<l
iMId. ItrorofQlo, b. IP9/0Ve.;!.
r'U811C COM'-lENT A cOPV 01 Ihe
NOC 15 00 lIIe Ind IYIII~bl. lor In.
sf-Wion at the OAf'CA aUite, 120 E.
&I.,e Ave OI,lI1lJ1a,
Publijl,td b~' _ Chorll!$ PI'ACJf, Co~lr<Jl
0"1(81 l-oO(HU ~623 Of 1200)
M6.0593.
fullli.h. JulJ J, ~ 9!Hl
Legal#
Ace t *
99l\5
41512259
Affidavit of Publication
55.
The undersigned being first duly sworn on oath
deposed and says: That she is tha Principal Clork
of The Olympian which is a legal newspaper printed
and published in the City of Olympla~ Thurston
County, Washington: of g.n~ral ~irculation in said
City, County and Statg; that thg
PUBLIC NOTICE
1n the ca~e of
OLYMPIC AIR POLLUTION
...............~----_._---......,....-----_.-..........--.-~.._~--.-.------.-----..-..----...-~'~.
of which the
published in
attached i~ d printed copy. was
said newspBperl
On the
day of
day of
dilY of
day of
day of
day of
1990~
1990:
1990:
1990:
1990:
1990.
3
JULY
the
the
the
thR
the
that the said nelyJspaper \;,1(\5 generally circulated
dur1ng all of said time, and has been publiBhsd
for moro than Gix months prior to the date6 of the
publicat10n of this legal document, and that 6~id
notice was published in the net,.Jspaper pl'opet'. and
not in supplement form.
The amount of fee charged
is $ 30.10
for this publication
-)
\~\-,~'~'~J l.~~t~JJl:J
....-~intlpa~le'...,k
'"::l
Subscribed and sworn to me this 10TH day of
August. 1990.
IiCra~~t;;t:t::.~~:::::t
':......!....-.
~~~<>-~
NotiHY I'uoll, and for the Stale or W~5hlng\{ln
rcsl,jlng at Olympia, Tllurston Country, Washington,
i.f
r'
('
',.itL)...--'-" ,...........,.- ..--....... ~..,.....
'rl1c Olympl.n hu been Ippolnlcd II . ItJlal nt....p,;po;l
~y Qrdcr Qf lI1c ~\Ip(rlvr ({lUll or Ihe SllllC o(
W"hln~Qn rQr TlMI",'n County, dllcd Ju1r 10, 1941,
In tho .oun!)lln which Uld ncwlp)~r II p\lbll.ht~ In
_.... ,'a...'.. ,J.L nl~ "'_IA ^'n .....I hI"'" A.r._t. I\..n
(1:: :':'E Ht'1 ~TOE. ':: HU' 'E. HGF. I GLOE HL
1 ~E(1 E:::1E::74
F . (1:::
Olympic Air Pollution Control Authority
120 East State Avenue
OLYMPIA, WASHINGTON 98501
(206) 352-4882
DETERMINATION FOR NOTICE OF CONSTRUCTION
YELM PROCESSING - NOC #629
Olympic Air Pollution control Authority has reviewed your Notice
of Construction. We are required by WAC 173.403.050 to make a
preliminary determination 30 days after all necessary information
has been ~eceived.
Preliminary determination is for approval of the Construction.
A pUblic not~ce will be published at the applicant's expense, in
which the business is locatedt at the applicant's expense.
If you have any questions concerning this determination, you may
contact the reviewing officer or the control officer during regular
business hours at 1-800-422-5623.
Charles Peace
Control Officer
Q_____ Q. lJ~~~
James (I. Wilson
Air Quality Control Specialist
Dated this 27th day of June, 1990.
HF F. -(10:: - ,ri" = Ut.j ~) = : LO:: Ht'1 JOE. = HU"E. HGF. I GLuE HL
>
1 ~t:O 0:::=10::=74
P. (1':;'
! II
~.~0',
.~ U'\"~-'~"'7'-...\~ '?
Ct.II...1 ~ 4
J.'h,lfIl
Olympic Air Pollution Control Authority
120 East State Avenue
OLYMPIA, WASHINGTON 98501
(206) 352-4882
June 27, 1990
Publisher
THE OLYMPIAN
P. O. Box 407
olympia, WA 98507
LEG~L PUBLICATION
Dear Publisher:
Enclosed is a public notice regarding Yelm Processing that we
would like to have published one time at your next available
publishing time.
Please bill this agency for your service.
sincerely,
(J~~L
Charles Peace
Control Officer
CP:klw
ENC!..OSURE:
AF~-06-97 SUN 03:~7 HM JOE.SAUVE.AGRIGLOBAL
...
1 360 6:31E 374
P. 10
PUBLI C NO'rI CE
OLYMPIC AIR POLLUTION CONTROL AUTHORITY
NOTICE OF CONSTRUC'rION (NOe.) AND APPLICATION FOR APPROVAL
Noe >>629
Yelm Processing Company
P. O. Box 532
Yelm., WA 96597
Pursuant to Section 7.01 (e) of Regulation 1, notice is hereby
given that the Yelm Processing Company has filed "Notice of
Construction and Application for Approval (NOe)" to install a
yeast drying facility, a potential odor source, at 925 N. P.
Road NW, (Yelm Industrial Park), Yelm.
PRELIMINARY DETERMINATION: Olympic Air Pollution Control Authority
(OAPCA) has completed a preliminary review and has determined that
the proposed installation will not adversely effect air quality
and meets all the requirements of Regulation 1 and should, therefore,
be approved.
PUBLIC COMMENT: A copy of the Noe is on file and available for
inspection at the OAPCA office, 120 E. State Ave, OlYmpia.
Published by: Charles Peace, Control Officer 1-800-422-5623,
or (206) 586-0593.
HF F..-EH: - 37 :: ut.j ",-~:::.:. 7 Ht'l _TOE.:: HU' 'E. HGF. I GLuE HL
1 :::'E~::1 E:::lt:::74
P. 11
NOTICE OF COMPLETION
WARNfNG:
Regula tion I ~ Section 7. 07(a). requires that the owner or applicant notify the agency of the
completion of the work covered by the application and when its operation will begin. This
Eonn is provided for your convenience to assist you in complying with this part of the
Regulation.
~I-:.LlCANT or (MNER SECrION
Mail to:
01~pic Air PQllution Control Authority
120 East State Avenue
Olympia. Waahington 98501
Gentlemen:
The proj ect described below was completed on .
on
and will be in operation
P--J
"'----
Signature of ~r and/or Applicant
Tille
1\it.e
. ......-.
wt
FOR MFN:.Y USE ONLY
T
N:Jtice of Construction }b. 437
"'.
1 V
Project Description:
Drying xeast bX ~ay of hot air
~
"
CMners Name
Location
Fred Ferguson
458-7040
YELM PROCESSING CO.
...,...
-
o . Inspector chec::.k
Follow-Up
D Engineer
and 1n.spector chet:k
(Estimated (J)mpletion Date Plus 15)
Date Inspected
~:..~
Inspector
-
"'--
".
o See Attachment
t4F F.:-~36- 37 = Ut.j ~:::13:':' =: Ht'1 JCIE. = HU' 'E. HGF. I GLOE t4L
1 ~EO E::::1E=74
F.12
'i
~ ~ OLYMPIC AIR POLLUTION CONTROL AUTHORIlY
, 120 East State Avenue
Olympia, Washington 98-501
Telephone (206) 352-48B1 'REC1t'VEO
NOT ICE 0 F CON S T RUe T ION JUN - 6 1990
AND OARCA
APPLICATION FOR APPROVAL
TO CONSTRUCT-INSTAll-ESTABLISH OR MODIFY
AN AIR CONTAMINANT SOURCE
BUSINESS V/) {
NAME: L<:LfV\ r eOCLs~/..v 6 0 '
MAILING ADDRESS
ADDRESS: Po \'!> - 5" J -z. Y(, ll-'ll 0UA.
NATUM OF
BUSINESS: {tls..- l)4 ,..v(,
TYPE OJ' PROCESS OR ME'fHOD
HoT A\R..
ZIP Cf
CODE I fiSt} -,
rILE
NO. 0:L
GRID
NO.
SIC
NO.
f)
M
2:
Q
c::
en
tr1
o
~
~
BEC
NO.
APP. N1J 7
LIST AIR CONTAMINANT(S) WHICH WILL BE PRODUCED AND/OR CONTROLLED:
~(w CR~ Y~A-5 I
ESTIMATED COST OP CONTROL: $
ESTIMATED / i
.. C~~PETION DATE: ~ I q 0
LOCATION OF FACILITY Yf.,L/V\ , Lv f\ .
NAME OF APPLICANT OR J .[212....-) / 0 <' ~ /V
OWNER OF BUSINESS: Ffttd. of c:;..''''l,,) J
TITLE :
COWN(/t
TELEPHONE:
<+s~ -10'1 0
I hereby certify that the information contained in this application,
including supplemental forms and data, when requited, is, to the
best of my knowledge, complete and correct.
SIGNATURE: y ~~
(Required by Regulation 1, as amended, Atticle 7)
AGENCY USE ONLY
CONDITIONALLY*
....
; I\rPnQ'IFl} 1M
corl'ii R(lf~ll,..)fj 0Nl'r
AS l'f.ING ^ rAClllH
IIi\VIIIG II~Gllllli.lJ
~ R[II';O~:t- ~Li: rIQ(fSS
~ (QUi,W.Hi 10 j)~
.. iJSHI rorl AI;!
t PaLlUllO,'j A!J^HMLN1
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Pag e l of 2
AFF.-OE-:;o7 ::Ut.j (H3 :.:.:: Ht'l ~TuE. ::HU"E. HGF. IGLOEHL
1 ~E~3 6::1E::74
F. 13
j
OLYMPIC AIR POLLUTION CONtROL AUTHORITY (OAPCA)
120 East StAte Avenue
olympia, WA 98501
( 206) 586 - 0 5 9 3 ex t . 101
ORDER OF APPROVAL
NOC #437
YELM PROCESSING CO_
This order of approval is issued in accordance with OAPCA Regulation
7.05 and WAC 173-403-050 (4) (b), which requires a new project to
use Best Available Control Technology (BACT) for emissions control,
and in accordance with WAC 173-403-050 (4) (d) which requires a
finding that the proposed new source will not cause a violation
of any ambient air quality standard.
OAPCA finds that the proposed source will use BACT as defined by
WAC 173-403-030 (8) when the following conditions are met:
1. All work areas will be of, or have the equivalence of, pavement
or concrete. Cleanliness will be maintained at all times and
and in all places of the process.
2. Yeast slurry will be dried immediately upon receipt.
3. If complaints about odors occur, then the company will be
required to take additional steps to reduce odors.
4. Ports will be available for stack testing.
5. The dryer will be stack tested, at the company's expense, within
90 days of start up. OAPCA must be notified within four weeks
of start up of a date for the test.
6. The particulate emissions from the dryer may not exceed 0.06
grains per dry standard cubic foot (0.06 gr/dscf).
7. An observer from OAPCA must be present during the tack test.
a. The wet scrubber will he equipped with a magJ)ehelic or equivalent
device to measure pressure drop. The ports co measure pressure
drop will be accessible so that OAPCA may verify the pressure
drop with their in~truments.
Dated this 3rd day of August, 1990.
James A. Wilson
Air Quality Control
Specialist
HF F,-€16-:;.7 -= Ut-.l 0:::::;:':;' Ht'1 .JOE.:: HU' 'E. AGf'. I GLOBHL
1 ~60 0::310:::374
P. 14
I)V""'UU;'';')~ UlwL.llI..;)c"; .;)Ln"I\"Cooi:ll
OEE1.~~n.~~~n OF LICENSING
P 0 eox 9034
OLYMPIA. WA WlS07.90:).4
UIJINUMIH:f1
MASTER BUSINESS APPLICATION
Please type or ptlnt clearly ir1 dark Ink,
BEFORE COMPLI:TING Tl-IIS FORM,
PLEASE SEE lHE INSTRUCTIONS ON PAGE 2.
lJfll5U:n HXl03
1. lIsr AEGISTRATI.ONS, LICENSES, TRADE ~AMES AND ANY AEaUIR~D FEES BELOW
See enclosed ~Reglstration and License Description Sheet" (or the Information needed to complete this list.
, ~,EG!JI TRATIO, N OR LICENSE TYPE
3812- ~~~t~-v\ .,.
$
FEE
~
$
... ~.. -
:-lo--.
-.-J
$
$
E:CEIVED $
____~~.~_~ 3 1994
$
LEo 1 olA - LOBBY $
....e:
$
Enclose check for total amount of all fees.
APPLICATION FEE
$
15.00
3{)/:E-
Make check payable to the WASHINGTON STA TE TREASURER.
TOTAL AMOUNT DUE
$
PURPOSE OF APPLICATION (You may check mor9lhan one box. MIll full instructions Oil pagll 2,)
Ll '-'\J8rl New Business 'ls(R;gISt9f Trade Namll 0 Change OWnofs.hlp 0 M(lrgl:lr 0 Hire EmploY99s
}Q Add UcoosQlReglslraUon 0 Change Trade NamQ 0 Opgn New LocadOrl OObt~ln Minor Work Pormit
tJ Hirll Domostio I:.mployoes
o Othllr ________
COMPLETE THE INf:=onMA liON WHICH APPLIES 1"0 YOUR I3USINESS OWNERSHIP
f!ER~ VS~~~FI2 cd~~, G/~_~;~ .J~~11~/q-tIS
PRO~~~:rOR ~rMZdle8! (sS.W~,po.:x'fJ;!L:."':S-..J~ ELM -:-0,4 9!SQ 7
Sp;mv (let Ftsf. MfddItl) hG O/lrTlll Qi I~ 'PQUS8 10 ~, on flls I~nae? Soda! SllWrily NvlTt>el
(j YES 0 NO
o lmhed (l/Ilrn/led mill na_ _KM,1/y if rllQf$rflf(! Itft/I Sfff,'a-y 01 SIAl'"
Sodal SllOJr~y NurTh1r
"33 -If'i-SqS ?
Home T GIophooG Hurrboi
~" )~forS.1'1~
COMPLE1!; ONLY BI1M~\~
FOR UOUOR Oil
LOHERY lICENSE
Nvrrtltl 01 P~1'IOf1
PAJnNERSt11P
list P ~rlAf'
In Sec.1l:lIl C
l'artl\ll"",1p UaJ~ AOJlttt {sw.r Q( Rovl', P,O. Bali. City, $I.r., lqlJ
CORPORATION
l~l CorjJOtalCl
Off~;er8In Se(.llort 0
CoIporallon Nl'IIT1il (E..IA::f/y e rfjJ/srlftd rr1111 S8ctlIf~ 01 SrAfB)
~I(I oI.-.eortnlalion
Numm ~ Colpollltll Ofllalrs
---..-.------..------.----.------....
Alelloy co.porlllt Offittr1ln Willhlnglon al&o Dk9tlorll and Shafeholders? $Ial~ 01 Inw'IXl'ali;>n
DYES 0 NQ
Til" rJ, O,gllnfatlon Buelneoe MlllRng AddroS5 (SIlOol Q( RQlIro, P.O, Bal, Cify. Sl81<<, lip)
OTHt:R
N9tllA 01111& OfgMlzalioo
SITE I ~ I 76'S>
\ F--' ,.,
OWNER f(fj') FJ;I?(.,-v<"OrJ PARCELl fff.~OCFt0r)30b
12<--.' ",ss ~06 e.j)vJA,,-~:S"/P.O;51 - '+15 TWNSP 17tJ
/ 1
INSTALLATION DATE f.I6 '9 D SEWAGE CONTRACTOR VJOOj)
. I I
SEPTIC I' I CUBIC I ~ SPACE RESERVED FOR
TANK SIZE ~OO _YARDS ROCK _..;>_ REPLACEMENT FIELD
cu. 'tb
~tJj) :
:J...S-
-
~
INDICATE THE FOLLOWING INFORMATION, IF KNOWN, ON THE
DRAWING'
1 RESIDENCE LOCATION AND DIMENSIONS.
2. PAVED SURFACES (I.E., PATIOS, DRIVEWAYS ETC,)
3, WELLS OR SURFACE WATER SOURCES
4. DIRECTIONS OF DRAINAGE.
5. SEPTIC SYSTEM LOCATION AND DEPTH TO TOP
TANK LOCATION - FROM HOUSE
FROM HOUSE CORNER
DRAIN FIELD LENGTH AND LOCATION
LOCATION & LENGTH OF ALL TIGHT LINES
6. LENGTH, LOCATION & DIMENSIONS OF ALL INTERCEPTOR LINES
7 LABEL ALL SETBACKS, I E. FROM WATER, PROPERTY LINES,
COUNTRY ROADS, ETC.
8. ASSUME AN ELEVATION OF 100 FEET AT ONE LOT CORNER AND
INDICATE THE OTHER LOT CORNER ELEVATIONS TO IT
9. USE ARROWS TO SHOW DIRECTION OF SLOPE.
ONE SQUARE EQUALS 10 FEET
TO BE BACKFILLED
AFTER INSPECTION
. ./
I J '<:1' d-'iI'EARTH COVER
..... PAPER OR STRAW
....1 J... ;: I STONE OVER PIPE
+1 "f:; I PIPE
+-1 6 (, ] STONE UNDER PIPE
I~l ~1..j.....'1 I--+I+- :)/+IJ SAND UN.1);=k:.
CROS$, SECTION OF TRENCH S TON t.
'j
nATE
CERTIFIED BY
.r ,
.~ -- . -
SEe J.j
t-~
+00 -r
THURSTON COUNTY HEALTH DEPARTMENT
RG ;lJ:. vJ 1.1\ I 2000 LAKERIDGE DR. sw
_I I OLYMPIA WA.98fJJ2
PHONE 753-8073
SO, FT
FINAL INSPECTION RECORD
THIS RECORD IS NOT A GUARANTEE OF PERFORMANCE. THE HEALTH
DEPARTMENT RECOMMENDS THE SEPTIC TANK ITSELF SHOULD BE PUMPED
AND INSPECTED EVERY THREE TO FIVE YEARS, DEPENDING ON HOW POOR THE
DRAINAGE IN THE AREA IS. REDUCTION IN HOUSE WATER USE WILL EXTEND
THE DRAIN FIELD LIFE
i
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\
APPROVED BY
Part Ele\'en-Chapter 197-11
SEP A Rules
RECEIVED
MAY 1 7 1990
TOWN Of ~
P ART ELEVEN - FORMS
RCW 197-11-960 Enrironmental checklist.
ENVIRONMENTAL CHECKLIST
Purpose of Checklist.
The State Environmental Policy Act (SEPA), chapter 43,2lC RCW. requires all governmental agencies to conSider
the environmental Impacts of a proposal before making decisions. An environmental "opact statement (EIS) musl be
prepared for all proposals with probable signIficant adverse Impacts on the quality of the environment The purposc of
thiS checklist IS to prOVide mformation to help you and the agency identify impacts from your proposal (and to reduce
or aVOId Impacts from the proposal, if It can be done) and to help the agency deCide whether an EIS IS reqUired
Instructions for Applicants.
ThIS environmental checklist asks you to describe some basic mformation about your proposal Governmcntal agen-
cies use thiS checklist to determine whether the environmental impacts of your proposal arc Significant, requiring
pn:paration of an ElS. Answer the questions brieny, with the most precise information known, or give the best de-
scnption you can.
You must answer each question accurately and carefully, to the best of your knowledge, In most cases, you should
be able to answer the questIOns from your own observations or project plans without the need to Ime experts, I f you
really do not know the answer, or if a question does not apply to your proposal, write "do not know" or "docs not ap-
ply. Complete answers to the questions now may aVOid unnecessary delays later
Some questions ask about governmental regulatIOns, such as zonmg, shoreline, and landmark designations. Answer
these questIOns if you can. lf you have problems, the governmental agencies can assist you,
The checklist questIOns apply to all parts of your proposal, even If you plan to do them over a period of time or on
different parcels of land. Altach any additIOnal mformatlOn that Will help describe your proposal or Its environmental
effects, The agency to which you submit tillS checklist may ask you to explain your answers or prOVide additional in-
formatIOn reasonably related to determinwg ,f there may be SignIficant adverse unpact
Use of checklist for nonproject proposals,
Complete 'this checklist for non project proposals, even though questions may be answered "does not apply" IN AD-
DITION, complete the SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (part D)
For nonproJect actIOns, the references in the checklIst to the words "project,. "applicant," and "property or sitc"
should be read as . proposal,. · proposer,. and "affected geographiC area," respectively
A. BACKGROUND
I Name of proposed project, If applicable: Yt.L/'V1
PR.u([55/ /UG UJ~
2, Name of applicant. ri2& f-z:::l26USo/[,/
3 Address and phone numbcr of applicant and contact person, ("iP8 ~L// 5" 'jUIYI) f.c,J Il 9YSC"J"7
4 Date checklist prepared. 5 ~~/90
5 Agency requesting checklist. ~ J L
6 Proposed timing or schedule (including phasing, if applicable) $771 /?'/ U I) -'7/ ) /90
7 Do you have any plans for future additions, expansion, or further activity related to or connccted with this proposal?
I f yes, explalll, ,IV U
ICh. 197-lt RCW-p 40)
(1983 Laws)
SEP A Rules
Part Eleven-197-11-960
II List any environmental information you know about that has been prepared, or will be prepared, directly related to
this proposal (\)0 IV (:
9 Do you know whether applications are pending for governmental approvals of other proposals directly affecting the
propcrty covcrcd by your proposal? If yes, explain (\)<0
10 List any govcrnment approvals or permits that will be needed for your proposal, if known cJc" ,1)0 r k,VDiJ
I J Give bnef, complete description of your proposal, including the proposed uses and the size of the project and site.
There are several questIOns later In this checklist that ask you to describe certain aspects of your proposal You do not
need to repeat those answers on this page. (Lead agencies may modify this form to include add,twnal specIfic IOfor-
matlOnonproJectdescnptlOn.) BUiLd iju,<IZo MfTA-L f;14/.1c:'t~ /]c.IIUI.v6 0 V" ,
/. 3 .4 (12.( ~ TO I-IOU SZ; A d It.. y( 11.. ..c.. /V j 10120 V' d cz. LU~ /1 {" 17 0L'S f/v ()
-h> 1.. S"A iV' ( .
12. Location of the proposal Give sufficient information for a pcrson to undcrstand the precise location of your pro-
poscd proJect, Including a street address, if any, and section, township, and range, if known, If a proposal would occur
over a range of area. provide the range or boundaries of the site(s) Provide a legal description, site plan, vicinity map,
and topographic map, if reasonably available. Whilc you should submit any plans required by the agency. you are not
required to duplicate maps or dctailed plans submitted with any permit applications related to this checklist.
C(ZS' ,Y.W IV. Pi IZCJ,qd Nw Y4 Nt?- '/<-/ St.'-. t9
Y[L./Vl -Lrv d us r CllA l r(~ flK I,' II\!, I Q.. 7.. E 'J l..J. iv'\.
'I{...LiV\, LUf\.
TO DE COMJ>LETED BY AI'J>L1CANT
EVALUATION FOR
AGENCY USE ONLY
B ENVIRONMENTAL ELEMENTS
I Earth
a, General description of the site {circle one>@rolling, hilly, steep slopes, mountainous,
other .
b, What is the steepest slope on the site (approximate percent slope)? / 0/0
(1983 Laws) ICh. 197-11 RCW-p 41)
Part EJet'en-197-11-960
SEPA nuJes
TO BE COMPLETED BY APPLICANT
EV ALUA TION FOR
AGENCY USE ONLY
c. What general types of soils are found on the site (for example, clay, Q~peat,
muck)? If you know the classification of agricultural soils, speCify them a~~o ny prime
farmland.
d. Are there surface indications or history of unstable soils in the immcdiatc vicinity'! If so,
dcscribc. NO
e, Describe the purpose, type, and approximate quanti tics of any filling or grading pro-
posed. Indicate source of fill 50 IV) t:: L E v~: L , /v G
f Could erosion occur as a result of clearing, construction, or use? If so, generally descrlbc, NO
g. About what percent of the site will be covered with impervious surfaces aftcr proJcct
construction (for example, asphalt or buildtngs)'? 3 <!'J <'/'0
h Proposcd measurcs to rcduce or control erosion, or othcr impacts to the earth. If any NU -0 ~_
2. Air
a. What typcs of emissions to the air would result from the proposal (i e" dust, automobilc,
odors, IIldustrial wood smoke) during constructIOn and whcn the project is completcd'? If
any, generally descrlbc and give approximate quantities if known Lv 4 T{ (!.. [1,4 po rZ-..
b. Arc there any off-site sources of emissions or odor that may affect your proposal'? If so,
generally desCribe, f1..90
c. Proposed measures tq T/?duce or control emissions or other impacts to air, if any' iU"1r{ fl .h4 r h
Itl {t... 5Lr< U 6bz- (2.
ICh. 197-11 RCW-p 421 (19113 \.aws)
SEP A Rules
Part Ele\'en-197-11-960
TO BE COMPLETED BY APPLICANT
3 Water
a. Surface:
I) Is there any surface watcr body on or in the immcdiate vicinity of the site (including
year-round and seasonal streams, saltwater, lakes, ponds, wetlands)? If yes, describe type
and provide names, If appropriate, state what stream or river it flows into, ru 0
EVALUATION FOR
AGENCY USE ONLY
2) Will Ihc proJcct rcquire any work over, in, or adjacent to (within 200 feet) the described
watcrs? If yes, plcasc describe and attach availablc plans. !lJ (;
J) Eslllnalc the amount of fill and drcdge material that would be placcd in or rcmovcd
from surface watcr or wetlands and indicate the area of the Sltc that would be affected In-
dIcate the source of fill matenal rv 0 'V ['
4) WIll the proposal requirc surfacc watcr withdrawals or diversions? Givc general de-
sCription, purposc, and approximatc quantities if known NO
5) Does the proposal he within a lOa-year floodplain? If so, note location on the site
plan ^-J 0
6) Docs the proposal involve any discharges of waste malenals to surface waters? If so,
dcscribc thc typc of waste and anticipated volume of discharge, IV 0
b. Ground
1) Will ground water be withdrawn, or will water be dischargcd to ground water? Give
general dcscrlption, purposc, and approximate quantities if known NO
2) Describe waste material that will be discharged into the ground from septic tanks or
other sources, If any (for example: Domestic sewage; industrial, containing the following
chemicals , agricultural, etc,) Describe the general size of the system, the number of
such systems, the number of houses to be served (if applicable), or the number of animals or
humans the system(s) are expected to serve, ~. 5 ELUA (0 (' / '~TO lL L T /-5/'vl<-.
. ~ ) }
(1983 Laws)
ICh. 197-11 RCW-p 431
Part Ele\'en-197-11-960
SEPA Rules
TO BE COMPLETED BY APPLICANT
c. Water Runoff (including storm water)
1) Describe the source of runoff (including storm water) and method of collection and
disposal, If any (include quantities, if known) Where will this water /low? Will this water
/low into other waters? If so, describe. NO/V t~-
2) Could waste materials enter ground or surface waters? If so, generally describe, III 0
d, Proposcd measurcs to rcduce or control surface, ground, and runoff water impacts, if
any' (\)G ~ ~
4 Plants
a. Check or circle types of vegetation found on the site:
_ deCiduous tree: alder, maple, aspen, other
_ evergreen tree: fir, cedar, pine, other
shruos
)S.. grass
_ pasture
_ crop or grain
_ wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other
_ water plants. water lily, eelgrass, milfoil, other
_ other types of vegetatIOn
b. What kmd and amount of vegetation will be removed or altered? 9 ~ A 55
c. List threatened or endangered species known to be on or near the site. (\)(01..1 t..
d Proposed landscaping, use of native plants, or other measures to preserve or enhance
vegetation on the site, jf any' No.lV L
5. Animals
a. Circle any birds and animals which have been observed on or near the site or are known
to be on or near the site: I
birds~~;~ heron, eagle, ~:~ir~ other' CI, VV/S /.' f'h C.-1 ~~ I
mamma ,deer, bear. elk, t:Other'. , . . . . . . . . .
fish, bass. salmon, trout, herring, shellfish, other"
b, List any threatened or endangered species known to be on or ncar the site. ,I\) C '\J 'Z
1Cb. 197-11 RCW-p 44)
EVALUATION FOR
AGENCY USE ONLY
(1983 laws)
SEPA Rules
Part Eleven-197-11-960
TO /If. COMPLETED IlY APPLICANT
EV ALUA TION FOR
AGENCY USE ONLY
c. Is thc sitc part of a migration route'! If so, explai"n NO
d. Proposed mcasures to preserve or enhance wildlife, if any' (\)(j ^' [~
6. Energy and Natural Resources
a What kinds of energy (electric, natural gas, oil, wood stovc, solar) will be used to meet
thc completed proJcct's energy needs? Describe whether it will be used for heating, manu-
facturing, etc, El...E... c,12./ C j (U,~'I U.q A L 6.45 ,'- P/2c.KL'S"S I V (;
b, Would your project affect the potential use of solar energy by adjacent properties? If so,
generally describe. NO
c. What kinds of cncrgy conservation features are included in the plans of tillS proposal?
List other proposed measures to reduce or control cnergy impacts, if any' (\)0 /V t
7 Environmental Health
.
a, Are there any environmental health hazards, including exposure to toxic chemicals, risk
of fire and explosion, spill, or hazardous waste, that could occur as a result of this proposal?
If so, desCribe, (\) a
I) Describe speCial emergency services that might be required. (\)0 V L
2) Proposed measures to reduce or control environmental health hazards, if anY' Nt) V [
b. Noise
I) What types of noise exist in the area which may affect your project (for example:
traffic, equipment, operation, other)? (\)0 It) L-
2) What types and levels of noise would be created by or associated with the project on a
short-term or a long-term basis (for example: traffic, construction, operatIOn, other)? Indi-
cate what hours noise would come from the site, <.. h V)......T -. () V C A"\ - 1/'1 .,... 0 V
-) 0,,-, I t.IL,. I, v.V,:> I '- U... I ( ,
4-0 t-Ia. LA,) k- ;
(1983 Laws)
leb. 197-JJ RCW-p 4S)
Part Eleven-197-11-960
SEP A Rules
TO BE COMPLETED BY APPLICANT
EV ALUA TION FOR
AGENCY USE ONLY
3) Proposed measures to reduce or control noise impacts, if any' B U I L jf//" (:-:_ Ius (.l C. ,I.::), (0 /j./
8. Land and Shoreline Use
a, What IS the current use of the site and adjacent properties? L i rt:.
r-uJU$ IlL Y
b. Has the site been used for agriculture? If so, describe, (\) 0
c, Describe any structures on the site. (\)0 N E.
d. Will any structures be demolished? If so, what? N (9
e. Wha' IS the curren' zoning classification or the "te? Ld ~S li1,^ L
f What is the current comprehensive plan designation of the site? l (\J d uS 1"' n., h-L
g, If applicable, what is the current shoreline master program designation of the site? N i A. .
h. Has any part of the site been classified as an "environmentally sensitive" area? If 50,10 0
speCify
Approximately how many people would reside or work in the completed project? 2
J Approximately how many people would the completed project displace" (\) 0 '\J 'L
k, Proposed measures to avoid or reduce displacement impacts, if any' (\:; () V [
I Proposed measures to ensure the proposal is compatible with eXIsting and projected land
uses and plans, if any' c.() \v\ ply W l,~ 2- () f\) I rU G CA-l,V S
ICb. 197-11 RCW-p 461
(1983 Laws)
SEPA Rules
Part Ele\'en-197-11-960
TO BE COMPLETED BY APPLICANT
EVALUATION FOR
AGENCY USE ONLY
9 Housing
a Approximately how many units would be provided, if any? Indicate whether high, mid-
dle, or low-income housing, NO V L
b. Approximately how many units, if any, would be eliminated? IndIcate whether high,
middle, or low-income hOUSing, N ~ I\J'- L
c, Proposed measures to reduce or control housing impacts, if any' IV C\ '\..' L
J 0 Aesthetics
a What is the tallest height of any proposed structure(s), not including antennas, what is
the principal extenor building matenal(s) proposed? 30.,') pA \IV t (. d ~\ t TA L
b What views in the ImmedIate Vicinity would be altered or obstructed? (\)0 '\J L
c, Proposed measures to reduce or control aesthetic impacts, if any' NO ''0 L
II Li~ht and Glare
a What type of light or glare will the proposal produce? What time of day would it mainly
occur? (U a,'\) L
b. Could light or glare from the finished project be a safety hazard or interfere with views? IU 0
c, What existing off-site sources of light or glare may affect your proposal? NO AJ L
d Proposed measures to reduce or control light and glare impacts, if any' (V 0 rU L
12, Recreation
a What designated and informal recreational opportunities arc in the immediate vicinity? I\) 0 't) L
b, Would the proposed project displace any eXIsting recreational us~s? If so, describe, (\J 0
(1983 Laws)
ICh. 197-11 RCW-p 471
Part Eleven-197-11-960
SEP A Rules
TO BE COMPLETED BY APPLICANT
"VALUATION FOil
AGENCY USE ONL'
c. Proposed measures to reduce or control impacts on recreation, including recreation op-
portuOltles to be provided by the project or applicant, if any' NO "t) L
13. Historic and Cultural Preservation
a. Are there any places or objects listed on, or proposed for, national, state, or local preser-
vation registers known to be on or next to the site? If so, generally describe, (V 0
b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or
cultural importance known to be on or next to the site, (\) 0 .N L
c. Proposed measures to reduce or control impacts, if any' N <0."\J L
14 Transportation
a. Identify public streets and highways serving the site, and describe proposed access to the
existing street system, Show on site plans, if any N. uJ N. P l \2...o.~d
b. Is site currently served by public transit? If not, what is the approximate distance to the
nearest transit stop? (\J 0) /UO /\.i L
c. How many parking spaces would the completed project have? How many would the
project elimmate? ~ I N C) /V L
d Will the proposal require any new roads or streets, or improvements to eXlstmg roads or
streets, not including driveways'! If so, generally describe (indicate whether public or
private) (\j 0
e, Will the project use (or occur in the immediate vicinity of) water, rail, or air transporta-
tion? If so, generally describe. (\) 0
f How many vehicular trips per day would be generated by the completed project?, If
known, indicate when peak volumes would occur. if g .. S' M 0 U. - .O~ i .
I
ICIa. 197-11 RCW-p 481
(1983 Laws)
SEPA Rulcs
Part Elcvcn-J97-J J-960
TO HE COMPLETED BY API'L1CANT
EVALUATION FOR
AGENCY USE ONLY
g, Proposed measures to reduce or control transportation impacts, if any' (\) 0 tV L
15 Public Services
a Would the project result in an increased need for public services (for example: firc pro-
tection, police protection, health care, schools, other)? If so, generally describe, tV 0
b, Proposed measurcs to rcducc or control direct impacts on public services, if any N()(IJ t.
16. Utilities
a _ Cir utilities currently available at the site:~ctric~tural ~~use se~)
(@9 tclephon , sanitary sewerCSeptlc syst~ othcr
b. Dcscribc thc utilitlcs that arc proposcd for thc project, the utility providing thc scrvicc,
and the gcncral constructIOn actlvitics on thc SltC or in thc immcdiatc vicinity which might
be nceded i:Lz:.c {/21 L ( 7' Y - PlY :JCl $C)\J t\JJ PO~ (/~ '. (
N A 'tv ~ ALGA- ~ W ~ l,'q tV <u ,0."U If\.) ~ \,V I'\? '" L <0 "'\ S - ,J ,
WAT(il. - ycLw\ UIILI ,IL~ Ot:pT.
I ELi-I:Jh lYVi - 'Yf:LIYl 'f'ri: if p)/ ()/!"{ C 6 . S t p,1 (1:: A-' STA 'IIA t'-(.. f"-J
c. SIGNATURE
The above answers arc true and completc to the best of my knowlcdge, I understand that
the Icad agency IS relYing on lhem to make its decision.
Signature: 'AC?~ ~
Date Submillcd S -/7 - o.:-) 0
(1983 Laws)
(Ch. 197-11 RCW-p 491
Part Eleven-197-11-960
SEP A Rules
TO BE COMPLETED BY APPLICANT
EVALUATION FOR
AGENCY USE ONLY
D SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS
(do not use this sheet for project actions)
Because these questions are very general, it may be helpful to read them in conjunction
with the list of the elements of the environment.
When answering these questions, be aware of the extent the proposal, or the types of
activities likely to result from the proposal, would affect the item at a greater intensIty or
at a faster rate than if the proposal were not implemented, Respond bneny and an general
terms.
I How would the proposal be hkely to Increase discharge to water; emiSSions to air; pro-
ductIOn, storage, or releaSf of tOXIC or hazardous substances; or productIOn of nOIse?
~(j)''v\ t:' 2Nd US,. \iLIA l (\) 0 I S L
Proposed measures to aVOId or reduce such increases are:
2. How would the proposal be likely to affect plants, animals, fish, or marine life? Dof S 1\)<....., A P pLY
Proposed measures to protect or conserve plants, animals, fish, or manne life arc:
) How would the proposal be likely to deplete energy or natural resources'! DClf S ,\)O'r A P pLy
Proposed measures to protect or conserve energy and natural resources are:
4 How would the proposal be likely to use or affect environmentally senSitive areas or ar-
eas designated (or eligible or under study) for governmental protection, such as parks, wil-
derness, wild and scenic rivers, threatened or endangered species habitat, historic or cultural
S1les, wetlands, noodplains, or prime farmlands? Do~s /U I) r A- P pL Y
Proposed measures to protect such resources or to avoid or reduce impacts are:
5 How would the proposal be likely to affect land and shoreline use, including whether it
would allow or encourage land or shoreline uses incompatible with existing plans" DO[ > ,Vt r f};:';"t.. y
ICh. t97-11 RCW-p SOl (19!lJ Laws)
" .
SEP A Rules
TO BE COMPLETED UY APPLICANT
Proposcd mcasures to aVOId or rcduce shorcline and land use impacts are:
6, How would thc proposal bc likcly to incrcasc demands on transportation or public ser-
vices and utllitics? ro 0 /lJ t
Proposcd mcasurcs to rcduce or rcspond to such dcmand(s) arc:
7 Idcntify. if possible. whcthcr thc proposal may connict with local. state. or fcderal laws
or rcquircmcnts for th~ protcction of thc cnvironment. (\) <9 /U L
(1983 Laws)
Part Eleven-197-11-960
EVALUATION FOR
AGENCY USE ONU
[Ch. 197-11 RCW-p 51)
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TOWN OF YELM
, ,
Buil~.ing\ DeI/artment
Pho~~i) 15PiS~~44
t. (Work must be st.a~ted within 120 days)~,,_ ~_ I 'y__ '-.;"/ r'~j
TOWN OF ,(f:.~ttl)/21))0); v/)..:!(' I ;:/( /1(1 Date 1 I 2.. (> (
I v-jJ,' (p //1?' 7 I'" -- /1<. Jt ---;-
I ~ ._ It) r~ , ~ ,/ .,/1... I~.. ," /' ~ t--
Site Address /. ..17 . ,/J, .-l-().<...1.. / . t/. Use of Structure (A.. ,/, . it (," './ /f.-.::-o
. 11 T.' .. /. ' -.:>. /' ;'-'" " ! /' .
OwneJ;:/1 r e: ,,{?O I !'(\(? /(...r Address") (.' I..? C (/(('/'.4 IZ(~; ). t~/...
r"'r-j' )~ 'v)' // /"/," fc" -', ," r:. ,- ,f ..., - 1__ r- / (/'
Contractod "<"'7 )(~ ;(1 {..':JI.U/(' "':;> - Address,_""~/}' " C.I r ././'-://(( ;.,:). (.. .
BUILDING PERMIT
~b
" ,dl ~,
;)"ll..-
r.:: 1 r- II B
.) , t,:i' f..)
Phonec-,6-,f'-70 t.../()
Ph c.:;/c;(-? - ;7(1 V ('-)
one. --' I .. ..
Subdivision
Lot
Block
or Short Plat No
Lot
Assessor's Parcel No
Lot Size (sq, ft, o. aC/es)
If an unplatted lot of record, was it created prior to July 29, 1974? Yes [J No 0 Section
What existing structures are located on the property?
Township
Range
Plot Plan
Description of Work /1/t:.-,c.)
.1'" / / A"'/ /
,,:'"/,'/ ~,..../ ~, ' /::-y~,
/
Item
Basis for Fee
Fee
Building
N~ ,..-:1('?1">
-~~ -<<
House Moving
/ I -.
,,1'. .l (., ')-;'Z'p /. ~.
I db ::..7-4
sssue y r.:.;;,?; "'''-
......::....~~ ,/ ,-
Plan Checkecfby
y S~~?
I Totai Fe~"./;l'/ 0'-":')
'/:1/ , ~
Minimum distance of structure from property lines.
",.o>~;l of
/~
jNOTE All Local Sales Tax generated by this Project I
should be coded '1407
FRONT
to of Road
SIDE SIDE
REAR
Use Zone
7;;t:.J
Type Const
j-'~/\/
Occupancy
Sewer
Septic
.r~ll!;t'j
Health Delft. . (I Access
Approval No,:),! 11'"1I Permit
APPLICANT'S AFFIDAVIT
I certify that I have read and examined the information contained within the application and know the same to be true and correct I also certify that the
proposed structure is in conformity with,all applicable Town of Yelm regulations including those governing zoning and land subdivision and in addition all covenants
easements and r~~ct!9;2S/of 7~d/ If applying as, a contractor I further certify that I am a c~:.:ntIY regis.tered c.. or:.~ractor in the State of Washington
'- / /-:,-~:......c /J' (-1" - I J-. (""-:--'1
. ~ -,' .j -.::'- Date _ Ie;". D
_. '1/ -- ',A:7Iictri<t) ;igrture7. '
!;{::. k 6 U (,a,v J 'V~i Ie!!! It ~
Firm
Date
Applicant must call for inspections listed below
Footing Inspection
(prior to pouring)
Framing Inspection
(prior to covering)
Drywall Nailing Inspection
Hnal
OFFICIAL LISE ONLY
Shoreline Permit necessary? Yes [] No []
Is the project exempt from SEPA? Yes [] No []