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STREETFILE
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City of Edmonds
Crit Ical Areas Checklist
no Critical Areas Checklist contained on
this fbrm is to be filled out by any person
preparing a Development Permit
Application for the City of 9dmonds prior
to his/her submittal of a development. permit
to the city.
The puipose of the Checklist is to enable
City staff to determine whether any potential
Critical Area are or may be present on the
subject property. The information needed to
complete the Cheeldist should be easily
available from observations of the site or
data available at City 11all (Critical Areas
inventories. maps, or soil surveys).
An applicant, or his/her representative. must
fill out the chooklis4 sign and date i4 and
submit it to the City. The City will review -
the checklist, make a precursory site visit,
and make a determination of the subsequent
step necessaxy to complete. a development
permit application.
with a signed copy of this fo rm, the
applicant should also submit a vicinity map
of the parcel with enoukh detail that City
staff can find and identify the subject
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information or studies in conjunction with
this Checklist to assist staff in completing
their preliminary assessment of the site.
I have completed the attached Critical Area Chec1dist and attest that the answers provided are
fkctuaL to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name
Title
Street Address
6-ty" State, ZIP
Phone
Signature Date
Applicant Representative:
-'.. '' Aoxc',
Name
-�7
Title
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Street Address
City, State, ZIP Phone
Signature Date
CIPItical Areas
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Site Information
Project Name: a&-"w Permit Number:
Site Location: Property Tax Aowunt Number.
.� �, :000 -Oc� _WC
Approximate Site Size (acres or square feet): WLI
Have you filled out a Critical Arm- C'hocidist for a projezt on this site before?
General Site Conditions <--? 6L4ev( 6q_-j< Ljt�,
1. Has the,site, been cleared or logged? Date of most recent acd=#
Soils / Topography . ppfflcj�jcwO
2. In the Snohomish County Sail Survey, what is the mapped soil type(s)? 4~ 6o
3. Describe the general site topography. Check all that apply. Z-0
Flat; less than 5 fed elevation change over entire site.
Rolling: slope$ on site generally lea than 15% (a vertical rise of 10 f a
cot over
horizontal distance of 66 foot)
Hilly: slopes present on site of =ore than 15% and less than 30% ( a vertical rise
of 10 fed of horizontal distance.)
—Steep: grades of greater than 300/a pres t o site -
Comments r�,4c,.,A �Nus ;, t-e_Ue_V% reo(� kuLs --C L+ buf ttW,(.�v
4k��I 3 4,_,.s_4 Kttfr -P/VJA [ouif r I -,eve-(,
Hydrology/Vegetation
4. Site contains areas of year-round standing water
5. Site contains areas of seasonal standing water. no _�.Approx. Deptli:
6'. Site is in the floodway floodplain_KL_)of a water course.
7. Site contains a creek or an area where water flowl across the grounds surface? �flows
are year-round? j� _oFlows are seasonal? 110
8. Site is primarily: forested meadow —;shrubs mixed X
9. Obvious wetland is present on site:
10. Wedand inventory or map indicates wetiand present on site:
11. Critical Areas inventory or map indicates any Critical Area on site: — J)� 0 ,
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APPLICATION
for
'k,rhe City of Edmonds Le SIDE SEWER PERMIT
NEW CONSTRUCTION.1t. REPAIRS
OWNER ---- I -- ---- -- ..................
ADDRESS . .... .. . . fl- ...................
LYNN PLMV
EASEMENT Nolf.,�..q..
,Z2
CONTRACTOR ..0 ..... C ..... U .......... C --- . 7 ............................. .. PERMIT No.
LEGAL DESCRIPTION: LOT No. ....9 .. I ................................ BLOCK No . ..........................................
1/1 1 , f 15
NAME OF ADDITION ..... ........................
76 ---
-7
/ -7
Approved:
DATE c- 7114�7 ...... By ... ......... ...............
....... t�l
NOTICE:
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of �Edmonds does not warrant the
accuracy of anything set forth on these
map(�_). Any person or entity -requesting a
copy should conduct an independent
inqu*iry regarding the information shown on
-map(s), including, but not limited to,
the lociation of any sewer stub shown. Such
sewer stubs may or may, not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
ernp-l-o-yee-s o-r office-r-s) shall be Via-H`e for +ffie
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS
Ci�ic CENTER — WATER -SEWER DEPARTMENT Can PROsPeft 6-IL107 vvhen woft
[a ready for Inspecuon. (No impec-
SIDESEWER PERMIT tions Saturday, Sunday or holidays.) N2 1933
ADDRESS ........................... ...... ..19428..-...81st Place West
.............. ... ..............................................................................................................................................
OWNER .....
- ---------------------------------- - ------------- CONTRACTOR ...... C�-AJL-q9jjq.TX!qq1i.on
Perruission is granted 5 , IL9.67.., for .....................
------ ----------------------- ..... - days, to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the Property may obtain a Permit to construct sewer inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer In street area. Do not cover any portion of sewer before it has been Inspected.
NOTE No. 2—ObtaIn full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%.
No bends in grade sharper than % will be permitted.
I No. 4—Trenches In street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
NOTE No. 5—It Is unlawful to alter or do any other work than is provided for In the permit, or to do any work on the main sewer or its ap-
purtenances except to insert the pipe Into the wye.