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19916 81 ST PL W
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STREET FILE
City of Edmonds
Critical Areas Checklist
The Critical Meas Checklist contained on
this form is to be filled out -by any person
preparing a Development Permit
Application for the City of Edmonds prior
to his/her submittal of a development permit
to the City.
The purpose of the Checklist is to cable
City staff to determine whether any potential
Critical Areas are or may be present on the
sukject property. The information needed to
complete the Checklist should be easily
available from observations of the site or
data available at City Hall (Critical Arms
inventories, maps, or soil surveys).
RECF.IVED
SEP - 4 1992
PERMIT COUNTER
An applicant� or his/her represenutive, must
fill out the, cheWist, sign and date it, and
submit it to the City. Ito City will review
the checklist, make a precttrsory site visit,
and make a of the subseqzicit
steps necessary to complete a development
permit application.
With a signed copy of this form, the
applicant should also submit a vicinity map
of the parcel with enough 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 die site.
I have completed the attached Critical Area Checklist and aftest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
0
Title
Street Address 226-- 5 cl-3 i
A/ —I— r
City, State, ZIP Phone
Applicant Representative:
Name
Title
Street Address
City, State, ZIP Phone
Signature Date
Signature
Date
Critical Areas Checklist -
Site Information
Prcject Name: O(L i f,-2 Permit Number.
Site Location: / Cl C116 07 /j/. Property Tax Account Number.
Approximate Site Size (acres or square feet): 00107620 es�A�T-
Have you filled out a Critical Areas C"necklist for a project on this site before?
General Site Conditions
60 ?�C/ =000-0,1610r,
i. Has the site been cleared or logged? A10 Date of most recent action:
Soils / Topography .4& -14 A be, 4/
2. In the Snohomish County Soil Survey� what is the mapped soil type(s)? t_+A10""Lek)
'a- er
3. Describe the general site topography. Check all that apply.
L/ --Flat less than 5 feet elevation change over entire site.
Jkolling: dopes on site generally less than 15% (a vertical rise of 10 feet over a
horizontal distance of 66 feet.)
JElly: slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10 fed of hor izontal distance.)
-Steep: grades of greater than 30% present on site.
Comments
Hydrology/Vegetation
4. Site contains areas of year-round standing waten &,10
5. Site contains areas of seasonal standing water Al 12 —Approx. Depth:
6. Site is in the floodway A/0 floodplain A/0 of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? _A10__flows
are year-round? Flows are seasonal?
8. Site is primarily: forested meadow ;shrubs L/ mixed 1/
9. Obvious wetland is present on site: Azo
10. Wetland inventory or map indicates wetland present on site-
11. Critical Areas inventory or map indicates any Critical Area on site:
APPLICATION
for
The City of Edmonds EET SEDE SEWER PERMIT VIM PLANT-
/15TR NEW CONSTRUCTION REPAIRS
r\
- / I - -g -;�7 -- /I - n 1)
OWNER ...... . d
- ------------------------------
ADDRESS......... ............ .......... ..........................
0
-0
z
EASEMENT No. ZAfV.6
CONTRACTOR ...................... PERMIT No. - C/7
LEGAL DESCRIPTION: LOT No. ...................... BLOCK No . ...........................................
NAME OF ADDITION ..... I.-
. ..........
............................................................................
C- lo.
'-'P P,-t J VE D
JAN 2.". 1967
Approved:
DATE By .. ......
U..... * ....... .. ........
a
pp�
0
C.1.TY-0F,--ED.-M0ND_S -1107' Wit �WOTII_
call Plitospect,.6 eTk..
JiV10 CENTER — WATER -SEWER DEPARTMENT is ready forAnspection. (No *tnsp6c-
tions'Saturday; sund . ay,or
holidays.).
'SIDE SEWER*- PERMIT
NO. 154-6-'
_1199 . 16-81st Place West .............. ...............................................................................................................
ADDRESS ................. ........................................................
-Tyl ... J4 .... Judd ................................................. CONTRACTOR C ... &..--U-...00nS-t . ............ ...........................
OWNER ....... DaX
Perinission, is granted ..... J'anuary ... 2_7 .............. 19.6.7, for-. ........... ....... days,,to REPAIR or CONNECT a side sewer
with City, . Sewers In accordance With aPPlication on. file and, governing ordinances.
A . TTENTION ISCALLED-TO TH E FOLLOWING:
A licensed Side Sewer Contractor must
NOTE No. I�The owners of the_property may obtatn.a permit to construct sewer inside Property line. At has been inspected.
be employed to,construct side sewer In street area. Do not co er.any.portion.of sewer before
NOTE No. 2--Obta . In full infor . mation r egarding Ordinance 11.16.030 and Aegulations 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.
NOTE No. 4—T . renches In street must be water settled and -surf-ace of street restored to original. condition. Contractors shall be responsible for
Jailure due to Improper work which may�develop within one year,of completion.
NOTE No. 6--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 toL Insert the pipe Into the wye.