Fillable Type II applications require a mailed notice to (Lewis County)

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Type II applications require a mailed notice to (Lewis County)

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Type II applications require a mailed notice to properties within 500 feet of the property and notice posted on
the road frontage of the project description. The administrator is the decision making body for the Type II
application.
The fol
lowing are required to be submitted with this Type II 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 requirements listed on application
Signed 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 app
eals will be heard by the Lewis County Hearing Examiner per the 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\Forms\2017
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\Forms\2017
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\Forms\2017
Updated January 2018
Pro
ject Name: ______________________________________ Permit Number: ____________
Brief Description of proposal:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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, Ve
hicles, and Traffic
Access Road: ______________________________
Please check one: □ Private Road □ County Road □ State Highway
□ Other: If other, please explain: _______________________
Number of parking spaces available: _____________ Number of parking spaces proposed: _______________
Lewis County Community Development
2025 NE Kresky Ave, Chehalis, WA 98532 ● Phone: (360) 740-1146 ● Fax: (360) 740-1245
ADMINISTRATIVE APPROVAL
Fees: The minimum fee due at the time of submittal is $280. Additional fees may apply.
Additional Information
:
Staff Applicant
□ □ Detailed summary identifying all uses proposed for the site, including direct and accessory uses. Approval
will be limited to only those uses shown on the application or maps. All other uses that are not shown will
be prohibited.
□ □ Soils report, as required by the Lewis County Sanitary Code, LCC 8.40 and 8.41, if new or altered onsite
sewage systems are proposed.
□ □ Any additional materials required by an administrator for the specific project.
□ □ If the proposed project is an animal kennel, shelter, boarding, grooming, or hospital that requires the
Lewis County Dog Kennel Operating Permit from Public Health and Social Services, a copy of the Lewis
County Dog Kennel Operating Permit is required to be attached.
S:\COMMUNITY DEVELOPMENT\Forms\2017
Updated January 2018
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 type and time of day? _______________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Site Characteristics
What type of commercial activity is proposed: ____________________________________________________
Hours of operation: __________________________________________________________________________
On average, how many customers do you expect per day: ____________________________________________
Will there be public assembly (church, event center, sports arena, etc.): □ Yes □ No
If yes, what type of public assembly is being proposed: ________________________________________
If yes, will the public assembly be within an enclosed building: □ Yes □ No
Explain: _____________________________________________________________________________
____________________________________________________________________________________
If the assembly is within an enclosed building, what is the occupancy load for the structures with
proposed public assembly? ________________
Total number of employees: ________________ Total number of employees living on site: _______________
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 give a description of the type and area in square feet of each use within the building (ex: commercial
dwelling space, storage, etc.): _________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
How do you propose to make the project compatible with the appearance and character of the surrounding
area? _____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What provisions have been made to safeguard the adjoining properties against any detrimental effects caused
by the development? ________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
S:\COMMUNITY DEVELOPMENT\Forms\2017
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\Forms\2017
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\Forms\2017
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\Forms\2017
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\Forms\2017
Updated January 2018
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Type II applications require a mailed notice to (Lewis County)

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Completed 10 October 2020

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