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2012, 02-24 Permit App: EGR-2012-001 Emergency Grading*Wane LAND DISTURBANCE PERMIT APPLICATION Community Development Department Permit Center 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 Tel: (509) 720-5240 Fax: (509) 688-0037 permitcenter@spoka neva Iley.orq (Staff Use Only) PERMIT No.: CHECKLIST?: ❑Y ❑N INIT: 1 STAFF USE ❑ ENGINEERED GRADING ❑ REGULAR GRADING 0 GRUBBING & CLEARING APPLICANT USE SITE ADDRESS: fe7I5 ASSESSORS PARCEL NO.: t/c- f col a APPLICANT NAME: € j Ci C /Ale .t 1\ JC. L EMAIL: PHONE: qr SS3 CELL: CONTACT NAME (0 SAME AS APPLICANT) : PHONE: Zri e EMAIL:kI&SC A, i&G"-ei‘5e Vvkx PROPERTY OWNER NAME: /71 e\ MAILING ADDRESS: / e7t.s' CITY: j j�Ci !`� V4 06)„ /ski/e1rei �G) !\\JC1 STATE: kJ)* CHECK IF APPLICANT PHONE: j( -(Cref 3:5'EMAIL: CELL: ZIP: crz©6 CONTRACTOR NAME: (a i3D): MAILING ADDRESS: CITY: STATE: PHONE: EMAIL: STATE LIC. NO.: EXPIRES: DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE: n CHECK TF APPLICANT Zd (Z- vuo oc oJs cv ?/-- a I j ru�-rte ESTIMATED QUANTITIES (CUBIC YD): CUT: IF CUT PROVIDE DESTINATION OF SOIL: START DATE: 7- 27-/z ,Ea' Le (414- K*) c (L< -E. Updatai March 2011 i / \\SV-FS2\Public Folders\Community Devfopment\02 Administration\03 Forms - Official Versions\Permit Center\Land Disturbance Permit & Checklist 3- 29-11.doc FILL: L /D ESTIMATED COMPLETION DATE: oc�J(e rs cc�e r5 V Z / Z4-- /20/Z_. Sikokalt� j17aley LAND DISTURBANCE (LD) PERMIT CHECKLIST For Grading, Clearing and Grubbing work outside the Right -of -Way (ROW) (For work within ROW need a ROW permit) Permit Center ♦ 11703 E Sprague Ave Suite B-3 • Spokane Valley WA 99206 509.688.0197 Fax: 509.688.0037 ♦ permitcenter®spokanevaltey.org Project Address: Today's Date: Project Description: Signature: Print Name: The purpose of this checklist is to gather information about the proposed project so to determine what land disturbance permit, if any, is required by the Spokane Valley Municipal Code. Starting with Part 1 and working from top to bottom, please answer the following questions. The first "Yes" identifies the type of land disturbance (LD) permit required. PART 1 — Is LD work exempted or already covered? (SVMC 24.50.020) If so then LD permit not needed. ❑ Yes ❑ No Does your project only have to do with emergency utility work; cemetery graves; eliminating septic tanks; digging out a basement; building a wall less than 4 feet high; disposal of refuse that is covered under other regulations; already permitted mining, quarrying, stockpiling of aggregate material (rock, sand, gravel, aggregate, or clay) or exploratory excavations done under the direction of a licensed engineer or engineering geologists? If yes, then project exempted from a LD permit. PART 2 — Engineered Grading Permit needed? (SVMC 24.50.030; 2 sets plans, calcs etc. from Engineer) ❑ Yes ❑ No Will this grading be for a short plat, subdivision or binding site plan? ❑ Yes ❑ No Will any grading occur in a FEMA floodplain, wetland, wetland buffer, Fish and Wildlife habitat conservation area or geologically hazardous area? ❑ Yes ❑ No Will the volume of excavation or fill for the project be over 500 cubic yards? (If checked Yes then a SEPA environmental checklist will need to be submitted for review) ❑ Yes ❑ No Will the grading create a base or support for a permanent structure? ❑ Yes ❑ No Will the grading be for a driveway that is longer than 75 feet? ❑ Yes ❑ No Will any grading occur in a drainage channel or be for a water feature (like a perennial or intermittent pond) with a surface area greater than 500 square feet? ❑ Yes ❑ No Will this grading result in the addition or replacement (excluding pavement maintenance) of 5,000 square feet or more of impervious surfaces or the disturbance of 1 acre or more land or the construction of new drywells or other underground injection control (UIC) facilities? ❑ Yes ❑ No Will any excavations or fills have slopes at 2:1 (H:V) or steeper and heights greater than 2'/ feet? ❑ Yes ❑ No Will any excavations or fills have slopes at 10:1 (H:V) or steeper and heights greater than 4 feet? PART 3 — Regular Grading Permit needed? (SVMC 24.50.040; 1 set of plans showing grading and temporary erosion and sediment control; does not require engineering) ❑ Yes ❑ No Will the volume of excavation or fill be over 50 cubic yards on any one lot? ❑ Yes ❑ No Will any excavations have slopes at 2:1 (H:V) or steeper or heights greater than 3 feet? ❑ Yes ❑ No Will any fills have slopes at 2:1 (H:V) or steeper or heights greater than 2 feet? PART 4 — Grubbing and Clearing (G&C) Permit needed? (SVMC 24.50.050; 1 set of plans showing G&C and temporary erosion and sediment control; does not require engineering) ❑ Yes ❑ No Will the G&C work disturb 5,000 or more square feet of area or remove 7 or more trees? (Note that forest practices overseen by DNR or commercial agriculture are exempt) ❑ Yes ❑ No Will there be any clearing on slopes or near/in FEMA floodplains, wetlands, wetland buffers, Fish and Wildlife habitat conservation areas, geologically hazardous areas or erodible soils? If the answers to all of the questions above are "No" then a permit is not required for the proposed work.