Fillable SPECIAL USE- MINING TYPE III APPLICATION Type III (Lewis County)

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SPECIAL USE- MINING TYPE III APPLICATION Type III (Lewis County)

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SPECIAL USE- MINING
TYPE III APPLICATION
Type III applications require a mailed notice to properties within 500 feet of the property, notice posted on the
road frontage, and notice published in the newspaper. A public hearing is required with the Lewis County Hearing
Examiner. The Lewis County Hearing Examiner is the quasi-judicial decision making body.
The followi
ng are required to be submitted with this Type III application to begin the review process:
STAFF APPLICANT
Completed Site Plan
(with all the requirements on the Lewis County Community Development ‘Site
Plan Requirements’ Handout)
Completed ‘General Information’ Application
Completed Permit Application for the associated permit
All additional information listed on application
Adequate Facilities Forms provided
(required for all projects other than development of a single-family residence or
large lot simple segregation where new development is not approved)
Not applicable; Explain: ______________________
SEPA
Not applicable; Exemption: ___________________
Application Fee
Any appeals
will be heard by the appropriate Court per Lewis County Code Chapter 17.05.
Lewis County
Community Development
2025 NE Kresky Ave, Chehalis, WA 98532
Phone: (360) 740-1146 ● Fax: (360) 740-1245
For Official Use Only:
Date of Completed Application: ____________________ Application Number: ________________________
Associated Permits: ______________________________ Permit Technician: __________________________
S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
Updated January 2018
STAFF
SITE PLAN REQUIREMENTS
This checklist is intended to give a general idea of the information required for a site plan. The
application should NOT be submitted unless all points below are addressed. The checklist must be
submitted with the application. Submit multiple maps if necessary. Additional information may be requested.
Any additional information which the applicant feels will assist in evaluating the proposal is encouraged.
Minimum size is 8.5x11-Maxiumim size is 11x17
APPLICANT
□ North arrow
□ Vicinity map with location and name of all roads surrounding the property
All property lines (if the parcel is large, provide a close up)
Setbacks from property lines for all proposed structures if an accurate scale is not
provided
Location and identification of all existing and proposed structures with dimensions.
Examples including, but not limited to: houses, sheds, barns, fences, culverts, bridges,
retaining walls, and decks
Distance from other structures if within 10 feet
□ Test holes, septic tanks, septic lines, drainfields, and reserve areas
□ Wells, well circles with a 100-foot radius, water lines, etc. and all utility easements
Distance between existing and proposed septic, wells, and buildings
Location of all existing or proposed driveways and dimensions, easements, access roads
etc. If there is an access easement, please provide a copy
Location and identification of any known critical areas on site. Examples including, but
not limited to, wetlands, streams or other surface waters, steep slopes, etc.
□ Location of any known and proposed stormwater facilities
Location, depth, and extent of any clearing, grading and filling
For all projects other than a single family dwelling, a description of the proposed use is
required. Examples include, but are not limited to: personal storage, commercial uses,
agricultural uses, garage, etc.
Lewis County Public Services
2025 NE Kresky Ave, Chehalis, WA 98532 ● Phone: (360) 740-1146 ● Fax: (360) 740-1245
S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
Updated January 2018
Lewis County Community Development
Signature: __________________________________________ Date: ____________________
Check one: Owner
Authorized Agent
GENERAL INFORMATION
Acknowledgment
I understand that County regulations require owner permission for County personnel to enter private property to conduct permit processing,
review, and inspections. I also understand that my failure to grant permission to enter may result in denial or withdrawal of a permit or approval. By
my signature below, permission is granted for representatives of the Community Development, Environmental Services, and Public Works
Department to enter and remain on and about the property for the sole purpose of processing such permits and performing required
inspections or reviews.
Prior notification of the date of inspections will take place is: Required Not Required
(________) ___________________ (Must provide phone number where applicant/representative can be reached)
I/We certify that all plans, specifications and other submissions required in support of this application conform to the requirements of all
federal, state, and local codes and applicable laws and ordinances; and I certify that I am either the current legal owner of this property or
their authorized representative. With this document, I take full responsibility for the lawful action that this document allows.
I certify that I have read and understand the limitations and conditions of Lewis County Code and agree to comply with all conditions of
approval. I understand that any permits issued by Lewis County, consistent with the attached site plan, are valid ONLY if construction is in
according to this plan and all other conditions of the permit are followed. By my signature below, I affirm that all the information and
documents provided with this application are true and accurate to the best of my knowledge.
Property Information:
Tax Parcel Number (s): ____________________________________________________________________________
Zoning: ____________________________________ Acreage: ____________________________________________
Site Address: ____________________________________________________________________________________
Owner’s Name: __________________________________________________________________________________
Owner’s Address: ___________________________________________________
_____________________________
Owner’s Phone Number: __________________ Owner’s Email: __________________________________________
_______ Quarter Section, Section _______, Township _______ North, Range _______ East/West (Circle One)
Applicant Information:
Name: _________________________________________________________________________________________
Mailing Address: _________________________________________________________________________________
Phone Number: __________________________ E-mail: ________________________________________________
Surveyor/Engineer or Other Contractor Information (Attach additional sheets if necessary):
Name: _________________________________________________________________________________________
Mailing Address: _________________________________________________________________________________
Phone Number: __________________________ E-mail: ________________________________________________
2025 NE Kresky Ave, Chehalis, WA 98532 ● Phone: (360) 740-1146 ● Fax: (360) 740-1245
S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
Updated January 2018
Project Name: ______________________________________ Permit Number: ____________
Brief description of proposal (Attach additional sheets if necessary): ____________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Lewis County Community Development
2025 NE Kresky Ave, Chehalis, WA 98532 ● Phone: (360) 740-1146 ● Fax: (360) 740-1245
SPECIAL USE-MINING
Fees: The minimum fee for a new submittal is $4,250. SEPA is not included is these estimates.
Additional fees may apply.
Additional
Information
:
Staff Applicant
□ □ A detailed summary identifying all uses proposed for the site, including primary and accessory uses.
Approval will be limited to only those uses shown on the application materials and specifically listed in
the project description of the Special Use Permit, SEPA Checklist, and maps that are approved by the Lewis
County Hearing Examiner. All other uses will be prohibited.
□ □ A Soils report, as required by the Lewis County Sanitary Code, LCC 8.40 and 8.41, if new or altered on-
site sewage systems are proposed.
□ □ The following needs to be addressed in the State Environmental Policy Act (SEPA) Environmental
Checklist
:
i. On site and off site critical areas, issues, protection and mitigation plans.
ii. Transportation infrastructure, including existing and proposed facilities and the phasing of impacts and
mitigation.
iii. Storm-water, including existing and proposed facilities, and the potential impact on off-site facilities,
critical areas, water resources, and all type streams.
iv. An analysis of the blasting, if applicable and potential risks and mitigation
v. Water source and uses and its effect on neighboring properties.
□ □ A map or series of maps beyond the requirements of the ‘Site Plan Requirements’ Handout, drawn at a
scale of 1” = 100’, which shows:
i. Boundaries of the individual ownership, or leasehold interest if the mine is confined to the leasehold
area.
ii. Well within the development area or within 500 feet of the boundary of the site, which are used for
domestic use or identified through well log or water rights records.
iii. Placement and size of buffer corridors for visual enhancement and noise and odor abatement (50-foot
setback with 25-foot screen within the 50-foot setback consisting of vegetation or other methods to
conceal the mine from public rights of ways or residential uses.
iv. Location of all adjacent residential structures within 200 feet of the mine boundary, if any
□ □ Legal description of all parcels affected.
□ □ A copy of the lease if the applicant is a tenant on the site.
□ □ A mine plan consistent with DNR reclamation requirements, together with a proposed phasing plan.
□ □ Narrative statement identifying how the proposed project will comply with the Lewis County Code
Sections 17.158.020, 17.158.024, and 17.158.030(11)
S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
Updated January 2018
Water Supply
:
Existing Source: □ Private Well □ Shared Well □ Public Water □ Group B □ Group A
□ Other; If other, please explain: _________________
Proposed Source: □ Private Well □ Shared Well □ Public Water □ Group B □ Group A
□ Other; If other, please explain: _________________
Sewage Disposal
Existing Method: □ Septic □ Public Sewer □ Other; If other, please explain: _____________
Proposed Method: □ Septic □ Public Sewer □ Other; If other, please explain: _____________
Access, Vehicles, and Traffic
Access Road: ______________________________
Please check one: □ Private Road □ County Road □ State Highway
□ Other: If other, please explain: _______________________
How many vehicle trips will be generated daily to and from the site by the proposed use? Please include
employees, customers, delivery trucks, etc. “Trip” means a one-direction movement that begins at the origin
and ends at the destination per LCC 12.60.030: __________________________________________________
How will these trips be distributed by mode and time of day? _______________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Site Characteristics
Total number of employees: ________________ Total number of employees living on site: _______________
Hours of operation: __________________________________________________________________________
Will there be on-site retail to purchase rock? ______________________________________________________
On average, how many customers are you expecting per day? ________________________________________
Existing
Proposed
Total
Number of Buildings
Gross Floor Area of all
Buildings, all Floors
Sq. ft. Sq. ft. Sq. ft.
Total Impervious Area
Sq. ft.
Sq. ft.
Sq. ft.
Please describe the size and use of each building: _________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
Updated January 2018
Will there be storage of hazardous, nonhazardous, or any other type of materials?
□ Yes □ No Explain: ___________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please describe the provisions proposed to make the proposed development compatible with the appearance
and character of the surrounding area? _________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please describe the provisions proposed to safeguard the adjoining properties against any detrimental effects
caused by the development? __________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
How close is
the nearest residence to the site? __________________________________________
How far are the mining operations from the property lines? _____________________________
How do you propose to conceal the mine from public rights of ways or residential development? (25-foot vegetation
buffer, fences, etc.)
______________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Are the mining operations within a critical aquifer recharge area? □ Yes □ No
If yes, show that the following criteria can be met:
• Fuel tanks and oil drums shall be double containment construction and protected by bermed areas having adequate capacity
to accommodate, contain, and allow the removal of petroleum spills. Fuel nozzles shall not contain locking devices. Fuel
storage shall be above ground. Fueling of mobile equipment shall be located at least twenty feet above the seasonal high
ground water level or within lined and bermed areas with adequate capacity to accommodate, contain, and allow the removal
of petroleum spills. Where the nature of the operation is such that the machinery cannot be moved for fueling, or the aquifer
is less than twenty (20) feet from the surface, the Hearings Examiner may approve an alternative fueling plan which
accomplishes aquifer protection.
• All operations shall maintain a fuels/hazardous waste management plan maintained by the operator and available on-site at
all times.
• Surface mines shall not use any noxious, toxic, flammable, compactable, or combustible materials not specifically authorized
by Lewis County Department of Health for backfill or reclamation. Non-contaminated process water used for gravel washing
shall be routed to settling ponds to minimize off-site discharges. A general permit from the Department of Ecology for process
and storm water discharge may substitute for these requirements.
• On-site truck and equipment wash runoff shall be routed to retention facilities equipped with an oil-water separator prior to
its release to settling ponds.
• Use of chemicals, petroleum or hazardous products, and disposal of such products, in concrete or asphalt plant operations
within critical aquifer recharge areas shall meet all the standards set forth in Chapters 90.48RCW and 173.303
WAC.
S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
Updated January 2018
ADEQUATE FACILITIES-FIRE
Date: __________________
Fire District: _____________________________
Dear Fire Commissioners or Fire Chief,
We are requesting a land use permit for _________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Located at _________________________________________________________________________
which lies within your district. Please respond below to indicate whether or not your district has the
capacity to serve the proposal or will have the capacity to serve the proposal at the time of
development.
Sincerely,
(Applicant)
Fire Commissioners or Fire Chief:
Adequate facilities mean: For residential or commercial buildings with a height of 35 feet and below,
two stories or less, and 50,000 square feet or less, the local fire district has the equipment and
personnel to serve the new facility without a change in the current level of service for similar facilities
existing in the district. For industrial or commercial over 35 feet in height, the district has the equipment
and personnel to serve the new facility consistent with the adopted standards of the district, including
local fire codes. Fire Districts can provide or secure adequate emergency services to this location for
the proposed project.
� Yes, we have the capacity to serve the proposed development, or will have the capacity at the
time it is developed.
� No, we do not have the capacity to serve the proposed development
Please print name: ____________________________________ Phone number: _________________
Signature: ______________________________________________________ Date: _____________
Lewis County Community Development
2025 NE Kresky Ave, Chehalis, WA 98532 ● Phone: (360) 740-1146 ● Fax: (360) 740-1245
S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
Updated January 2018
ADEQUATE FACILITIES-LAW ENFORCEMENT
Date: ______________
Law Enforcement Agency: ___________________________________
Dear Sheriff or Police Chief,
We are requesting a land use permit for _________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Located at _________________________________________________________________________
which lies within your district. Please respond below to indicate whether or not your district has the
capacity to serve the proposal or will have the capacity to serve the proposal at the time of
development.
Sincerely,
(Applicant)
Sheriff or Police Chief:
Adequate facilities mean: The Law Enforcement Agency can provide adequate emergency services to
the location of the proposed development.
Yes, we have the capacity to serve the proposed development, or will have the capacity at the
time it is developed.
No, we do not have the capacity to serve the proposed development.
Please print name: ___________________________________ Phone number: __________________
Signature: ______________________________________________________ Date: _____________
Lewis County Community Development
2025 NE Kresky Ave, Chehalis, WA 98532 ● Phone: (360) 740-1146 ● Fax: (360) 740-1245
S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
Updated January 2018
ADEQUATE FACILITIES-REFUSE DISPOSAL
Date: ______________
Disposal Company: ___________________________________
To whom may concern,
We are requesting a land use permit for _________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Located at _________________________________________________________________________
which lies within your district. Please respond below to indicate whether or not your district has the
capacity to serve the proposal or will have the capacity to serve the proposal at the time of
development.
Sincerely,
(Applicant)
Disposal Company:
Adequate facilities means: facilities are available where the project does not adversely affect the ability
of the local and/or regional solid waste authorities from accomplishing the goals and objectives of the
adopted county solid waste comprehensive plan. Adequacy includes pick up, transport, disposal, or
transfer of solid waste.
Yes, we have the capacity to serve the proposed development, or will have the capacity at the
time it is developed.
No, we do not have the capacity to serve the proposed development.
Please print name: ___________________________________ Phone number: __________________
Signature: ______________________________________________________ Date: _____________
Lewis County Community Development
2025 NE Kresky Ave, Chehalis, WA 98532 ● Phone: (360) 740-1146 ● Fax: (360) 740-1245
S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
Updated January 2018
ADEQUATE FACILITIES-SCHOOLS
Date: ______________
School District: ___________________________________
To whom may concern,
We are requesting a land use permit for _________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Located at _________________________________________________________________________
which lies within your district. Please respond below to indicate whether or not your district has the
capacity to serve the proposal or will have the capacity at the time of development.
Sincerely,
(Applicant)
School District:
Adequate facilities mean: For residential uses, the school can reasonably accommodate the school
population anticipated from the new development within existing facilities, together with state or
federal funds expected as a result of growth or changes within the district. For commercial or industrial
uses, the traffic or other impact to the school does not interfere with reasonable school operations or
safety.
Yes, we have the capacity to serve the proposed development, or will have the capacity at the
time it is developed and the proposed project does not interfere with reasonable school
operations or safety.
No, we do not have the capacity to serve the proposed development or it interferes with
reasonable school operations and/or safety.
Please print name: __________________________________ Phone number: ___________________
Signature: ______________________________________________________ Date: _____________
Lewis County Community Development
2025 NE Kresky Ave, Chehalis, WA 98532 ● Phone: (360) 740-1146 ● Fax: (360) 740-1245
S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
Updated January 2018
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SPECIAL USE- MINING TYPE III APPLICATION Type III (Lewis County)

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Completed 21 January 2021

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