21215 96TH AVE W.PDF9402
21215 96TH AVE W
CA FILE NO.
Critical Areas Checklist
------------------ *1 -----------------------
Site Information (soils/ topography/ hydro ogy/vegetation)
1. Site Address/ Location:
4
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? �1—� no.
yes;
If yes; how is site developed? / �2 2 5
5. Describe the neral site topography. Check all that apply.
7;Zlart: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet),
Hilly: slopes present on site of more than 15% and less than 30% ("a vertical
rise of 10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater t ' han 30% present on site (a vertical rise of 10-feet over
a horizontal distance of less than 334eet).
Other (please describe):
6. Site contains areas of year-round standing water: Jlt?i5,� ; Approx. Depth:
7. Site contains areas of seasonal standing water: /?C�> ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway__z�?O floodplain— ofawatercourse.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are
year-round? 40��2 Flows are seasonal? (What time of year?
10. Site is primarily: forested ; meadow shrubs- mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site:
ce
For ity Staff Use Only_
Site is Zoned?
::2. SCS mapped soil typp(s)? rVe,,e-�r d 0 AC"4 �/o
:3. Wetland invento' or C.A. map indicates we site?
ry tland present on
4. Critical Areas inventory or C.A. map indicates Critical Area. on. site? /-/0
::5. Site within designated earth subsidence landslide h A>
azard area?.
Site designated -on the Environmentally Sensitive Areas.Map?
^ca—chiLdoc, Rev 02/11/97
City of Edmonds 5EP
N�W CRITICAL AREA8 11 OR CkLIST
The Critical Areas 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 enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The
information needed to complete the Checklist should
be easily available from observations of the site or
data available at City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a deten-nination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
Name
Street Address
city State Zip
Telephone
Signature
Date
c:reccption\jana\cac1.doc
Applicant Representative:
Name
Street Address
City State Zip
7-
Telephone
Signature
'7 7
Date
(over)
APPLICATION
for
The City of Edmonds SEDE SEWER PERNaT
NEW CONSTRUCTION [] REPAIRS C] EASEMENT No . ..........................................
110-00400
OWNER------------- O.a.njes ... E�.---J.Jebpr ............................................................ CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ........ 2.121.5 .. mt ... 96th ... Ave....0 . ............................................. LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
E
NAME OF ADDITION
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................