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APPLICATION SHORELINE PERMIT(S) CITY OF LACEY Community & (City of Lacey)

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FORM: SL-1
PAGE 1
CITY OF LACEY
Community & Economic Development Department
420 College Street SE
Lacey, WA 98503
(360) 491-5642
SHORELINE PERMIT(S)
APPLICATION
DATE:
DATE:
DATE:
DATE:
SIGNATURE(S)
I (We), the above-signed, do hereby affirm and certify, under penalty of perjury, that I/we am/are one (or more) of the
owner(s) under contract of the below described property and that the following statements and answers are in all
respects, true and correct on my information and belief as to those matters.
OWNER NAME:
MAILING ADDRESS:
CITY, STATE, ZIP:
TELEPHONE:
APPLICANT NAME:
MAILING ADDRESS:
CITY, STATE, ZIP:
TELEPHONE:
SIGNATURE: DATE:
PROPERTY ADDRESS:
DIRECTIONS TO SITE:
OFFICIAL USE ONLY
Case Number: ___________
Date Received: __________
By: ___________________
Related Case Numbers:
_______________________
_______________________
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FORM: SL-1
PAGE 2
WATER BODY:
SHORELINE DESIGNATION:
Applicant shall provide TWELVE COPIES of the following information for all types of shoreline
permits:
1. This completed application; and
2. Supporting data in the form of a site plan and vicinity map.
Current use of property with existing improvements:
Proposed use of property (please be specific):
TO BE COMPLETED BY LOCAL OFFICIAL:
Nature of existing shoreline (type of shoreline—lake, stream, etc.; type of beach – high bank, erosion, etc.;
material; and, extent and type of bulkheading, if any):
If structures will exceed 35’ in height, indicate location and number of residences that will have an obstructed
view:
If a conditional use or variance, set forth in full the portion of the master program which allows the conditional
use or from which the variance is being sought:
TOTAL ACREAGE OF THE SITE: ____________________________________________________________
SECTION: ____________________ TOWNSHIP: ________________ RANGE:________________________
ASSESSOR’S PARCEL NUMBER(S):
FORM: SL-1
PAGE 3
MAPS REQUIRED FOR ALL TYPES OF SHORELINE APPLICATIONS
Draw all site plans and maps to scale, clearly indicating scale on lower right corner
and attach them to the application.
A. Site Plan – Include on Plan:
1. Site boundary. Show all driveways and access roads.
2. Property dimensions in vicinity of project. Show any structures within 300’ of the site.
3. Ordinary high-water mark.
4. Typical cross section or sections showing:
a. Existing ground elevations.
b. Proposed ground elevation.
c. Height of existing structures.
d. Height of proposed structures.
5. Where appropriate, proposed land contours using five-foot intervals in water area and ten-foot
intervals on areas landward of ordinary high-water mark, if development involves grading,
cutting, filling, or other alteration of land contours.
6. Show dimensions, including height, and locations of existing structures.
7. Show dimensions, including height, and locations of proposed structures.
8. Identify source, composition, and volume of fill material.
9. Identify composition and volume of any extracted materials, and identify proposed disposal
area.
10. Location of proposed utilities, such as sewer, septic tanks and drainfields, water, gas,
electricity.
11. If the development proposes septic tanks, does proposed development comply with local
health and state regulations?
12. Shoreline designation according to master program.
13. Show which areas are shorelines and which are shorelines of state-wide significance.
B. Vicinity Map:
1. Indicate site location using natural points of references (roads, state highways, prominent
landmarks, etc.)
2. If the development involves the removal of any soils by dredging or otherwise, please identify
the proposed disposal site on the map. If the disposal site is beyond the confines of the
vicinity map, provide another vicinity map showing the precise location of the disposal site
and its distance to the nearest city or town.
3. Give a brief narrative description of the general nature of the improvements and land use
within one thousand feet in all directions from development site (i.e., residential to the north,
commercial to the south, etc).
FORM: SL-1
PAGE 4
VARIANCE REQUEST
I request a variance from the requirement for (cite shoreline requirement):
Proposed Setback: Required Setback:
This request falls into one of the following three categories and meets all required conditions as specified for
that category (NOTE: Variance requests not meeting these conditions must be filed as a Shoreline Variance
Permit and reviewed by the Hearings Examiner).
1. DECREASED SETBACK IS JUSTIFIED BY EXISTING NEIGHBORING STRUCTURES
WHICH FRINGE ON THE REQUIRED SETBACK. (Chapter XV, General Regulations 13.b)
The average setback of all structures within 300 feet of each property line is: __________ feet.
My building would meet or exceed thus average setback (NOTE: Vacant properties shall be counted as
meeting the required setback in making this calculation).
A site plan is attached showing the location and type of all structures within 300 feet of the property
lines on this lot.
2. LOT SIZE PRECLUDES MEETING SETBACK REQUIREMENTS.
The lot does not conform to Shoreline Master Program requirements as follows (i.e., size and dimension):
The proposed building cannot be set back any further from the shoreline because:
3. REQUEST IS FOR EXPANSION OF EXISTING NONCONFORMANING STRUCTURE
PARALLEL TO WATER.
The proposal is compatible in terms of use and appearance and other factors with neighboring land uses as
follows:
The following steps have been taken to minimize inconsistency with regulations and adverse impacts from
the expansion:
The variance would not set a precedent which would cumulatively result in development inconsistent with
the Shoreline Master Program because:
FOR STAFF USE ONLY
DISPOSITION OF CASE: [ ] Approved [ ] Denied [ ] Modified
PLANNER SIGNATURE: DATE:
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APPLICATION SHORELINE PERMIT(S) CITY OF LACEY Community & (City of Lacey)

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Completed 3 August 2020

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