Fillable Form 4: GENERAL APPLICATION AMENDMENT SHORELINE MASTER PROGRAM (City of Lacey)

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Form 4: GENERAL APPLICATION AMENDMENT SHORELINE MASTER PROGRAM (City of Lacey)

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FORM: SLMP-1 PAGE 1
CIT
Y OF LACEY
C
ommunity & Economic Development Department
4
20 College Street SE
Lacey, WA 98503
(360) 491-5642
SHORELINE MASTER PROGRAM
AMENDMENT
GENERAL APPLICATION
OWNER NAME __________________________________________________________________________
Mailing Address __________________________________________________________________________
City, State, Zip Code __________________________________________________________________________
Telephone Number __________________________________________________________________________
AP
PLICANT NAME __________________________________________________________________________
Mailing Address __________________________________________________________________________
City, State, Zip Code __________________________________________________________________________
Telephone Number _______________________________ E-mail address _____________________________
Address of Proposal __________________________________________________________________________
* The applicant is the person whom staff will contact regarding the application, and to whom all notices and reports shall be sent, unless
otherwise stipulated by the applicant.
GENERAL DESCRIPTION OF PROPOSAL
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
GE
NERAL LOCATION OF PROJECT (Give street address, or if vacant, indicate lot(s), block and subdivision;
or tax lot number, access street, and nearest intersection.) _______________________________________________
_____________________________________________________________________________________________
Section: ____________________ Township: ______________________ Range: _________________________
Assessor’s Tax Parcel Number: ___________________________________________________________________
Full legal description of subject property (attach additional sheet if necessary): _____________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
OFFICIAL USE ONLY
Case Number: ____________
Date Received: ___________
Planner: _________________
Related Case Numbers:
________________________
________________________
________________________
*
FORM: SLMP-1 PAGE 2
SHORELINE MASTER PROGRAM, COMPREHENSIVE PLAN, ZONING, AND LAND USE ISSUES
Current Shoreline Master Program Classification: _____________________________________________________
Comprehensive Land Use Plan Designation: _________________________________________________________
Current Land use and improvements: _______________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
_____________________________________________________________________________________________
Past Land use or history: _________________________________________________________________________
______________________________________________________________________________________________
____________________________________________________________________________________________
Current Shoreline Master Program language (if applicable): _____________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
_____________________________________________________________________________________________
Requested new Shoreline Master Program language (if applicable): _______________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
_____________________________________________________________________________________________
Does the proposed amendment affect both the City and Thurston County? Please explain. ____________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
_____________________________________________________________________________________________
Was this issue, or property and its designation, discussed during the Shoreline Master Program development,
review, and adoption process? If so, please explain. ___________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
____________________________________________________________________________________________
Is the present Shoreline Master Program language, or designation and underlying zoning, the result of a mistake?
What kind of mistake (i.e., mapping, typographic)? Please explain. ______________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
____________________________________________________________________________________________
Will the proposed Shoreline Master Program amendment or map redesignation substantially benefit the public or
surrounding property? Please explain. _____________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
____________________________________________________________________________________________
If the amendment is a map amendment, how many acres of developed and undeveloped property in the Lacey
growth area already exist in this designation? Developed: ________________ Undeveloped: ________________
How will the amendment change this? ______________________________________________________________
______________________________________________________________________________________________
Is there a demonstrated need for this change and is it a wise allocation of land resources? Please explain. _________
______________________________________________________________________________________________
______________________________________________________________________________________________
_____________________________________________________________________________________________
FORM: SLMP-1 PAGE 3
Explain the need for change and how the amendment is consistent with the following:
State Growth Management Act (GMA) ____________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________________
County-wide Planning Policies (CWPP)___________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Lacey Comprehensive Plan _____________________________________________________________________
____________________________________________________________________________________________
___________________________________________________________________________________________
Regional Transportation Plan (RTP) ______________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________________
Other applicable City plans or documents _________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Neighboring jurisdictions’ shoreline program (where your proposal affects multiple jurisdictions, for example
Olympia or Tumwater) ________________________________________________________________________
___________________________________________________________________________________________
UTILITIES AND ROADS
Water supply (name of utility if applicable) _________________________________________________________
[ ] existing [ ] proposed
Sewage disposal (name of utility if applicable) _______________________________________________________
[ ] existing [ ] proposed
Access (name of street(s)) from which access will be gained ____________________________________________
SUPPLEMENTAL INFORMATION
This application must be accompanied by the following information and the associated application fee:
1. A complete list of all property owners within a 300’ radius of the external boundaries of the subject property, as
listed on the records of the Thurston County Assessor, and their mailing (not site) addresses on labels and on paper.
2. A site plan drawing or drawings at a scale of not less than one inch for each 200 feet which shall include or show:
a. The boundaries of the property
b. Size of property impacted by amendment
c. Location of existing natural features, such as trees, streams, or lake frontages
3. Environmental Checklist (SEPA) (must include 2 CD’s containing .pdf copies of all submittal materials,
including applications)
4. Supplemental information and/or special reports may be required, including:
a. Environmentally sensitive areas and issues
b. Traffic impacts
c. Other
5. Vicinity Map
INITIATED BY:
[ ] Planning Commission (date of initiation) ________________________________________________________
[ ] City Council (date of initiation) _______________________________________________________________
[ ] Property owners as follows _______________________________________________________________
I (we) understand and agree with the above explained need for the map change and are current owners of the
property within the City of Lacey.
SIGNATURE PRINTED NAME ADDRESS
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Dated this ___________ day of _____________________, ________.
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FORM: SLMP-1 PAGE 4
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Form 4: GENERAL APPLICATION AMENDMENT SHORELINE MASTER PROGRAM (City of Lacey)

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Completed 3 August 2020

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