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 foll
owing 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’ form
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 appe
als 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\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
Parcel Number: _________________________________ Permit Number: ________________
Requesting setback reduction to: _________ feet from the side property line
_________ feet from the rear property line
The proposed structure is ________________ square feet.
The proposed structure is: Residential
Commercial
Industrial
Other
The property abutting the rear yard setback is: Residential
Commercial
Industrial
Other
Reasons existing setbacks cannot be met (i.e. topography, critical areas, or the lot size or configuration).
Applications submitted without reasonable justification for reduction in setbacks cannot be approved):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please explain why the building/structure cannot be located elsewhere on the parcel that will meet the
setbacks: __________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Lewis County Community Development
2025 NE Kresky Ave, Chehalis, WA 98532 Phone: (360) 740-1146 Fax: (360) 740-1245
ADMINISTRATIVE REDUCTION-SETBACKS
Fees: The minimum fee due at the time of submittal is $280. Additional fees may apply.
This reduction in setback is for the side and/or rear property lines only. Reduction in the setbacks from County or State
right-of-way must be approved by application thru Lewis County Public Works or WA State Department of Transportation.
S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
Updated January 2018