23420 HUMBER LN.PDF11802
23420 HUMBER LN
CA File No: 4 03
Critical Areas Checklist
Site lnfbrmation (soils/ topography/ hydrology/vegetat:'ion)
1. Site Address/ Location: o? 3 L/cP F
>.57
2.- Property Tax Account Number:
3. Approximate Site Size,(acres or�square,
4.. Is this'site cuffentlydeveloped? yes; no.
If yes; how is site developed? A�F si
5. Describe the general site topography. Check all that apply.
� less than 5-feet �levation change over entire site.
Rolfing: slopes. on site, 'erally less I than 15% (a vertical rise of 10-feet over a horizontal
distance of 66-fe A).
Hilly: slop,�'s pre ' sent c n 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' than 30% present on site (a vertical rise of 10-feet over a horizontal
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round stand ing water:
Approx. Depth:
7., Site contains "areas' of VN7 -
seasonal standing -water: - tJ Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
Flows are'seasonal? ffhat time of year?
10. Site is primarily: forested meadow ;shrubs/ mixed
urban landscaped #awn, shrubs etc)
11. Obvi6us *e6nd ils'present on site: A�6)
Staff'l�e
.-n 'Ptly '.. I " , . .
1. Plan Check Number, if applicable?
2.- Site is 12�oned"?
3. SCS mapped soil type(s)?
'i. triticil Areas ifivent6iy'or �A. ma dicates Critical Area� ii A�sii�
do-
4L,
4r� �"- .4 'A*r4J, M A.�,Aa 51
arth;suWidence 1
5. Sitewit�m'd'esik'na'�'-'d e. ancltslide hazard area?
CliticA Meas Checikfist.doc/4.22.2003
OP11 1A
!!� 4C I
Date:
Us
1 fl-t'AU 17
WAIVER
Ile 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 the application 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 aviflable.at
City. Hall (Critical areas inventories, maps, or soil
surv�ys).
A
property owner, or,-his./helr: auth6rized repre4entative,
must fill out the checklist, sign and! date it, and submit it
to,ttid'Ciiy. The'Cit�'Wili rievie'w'.�& checklistj make a
precursory site visit, and make' a,determinatioh of the
subse
.quent steps necessary to complete a'devdlopment
permit application.
Please submit a,vicinity map, along with the signed copy
of this -form to as�ist-City stAff in enoidin, and locating the
9
,specific -piece of property described'on this form. In
addition,. the applicant shall Jnclu& other pertinent
information (e.j.'.,site, plan,. topography map,,'et�.)' or
studies in conjunction with this Checkli�t to assistant staff
in completing tl�oir preliminary assessme�nt of the,'i site.
IMe undersigned applicant, and hi&/her/its heirs, and ass'igns,-m cohsiderationlon the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless . from.,;iny and all dama ' s, including reasonable
9�
attorney's fees, arising from any action or infraction based'in whole -or part uponi false, misleading','inaccurate or
incomplete information furnished by the applicant, his/her/its.agents or employ��ees.-
By my signature, I certify that the information and exhibits herewith submitted are true and correct to thebest of my
knowledge and that I am authorized to file this. application on the behalf of the:owner as listed below.
SIGNATURE OF APPLICANVAGENTA�,& 3c"'10 (V�p �__'DATE
Property Owner's Auithorization
By my signature, I cer* that I have authorized the above Applicant/Agent to apply for the'subject land use application,
and grant my permission for the public officials and the staff of the City of EdrWonds to enter the subject property for the
purposes of inspection and posting attendant tothis� I application.
SIGNATUREOFOWNE A61_�Jva.Len� -DATE C)
6
Owner/Applicant: Applicant Representative:
tqt_�&C5 G-WPW 2AS E/(�_-D ROO,
Name Name
5X'�) hA 4q
,13D-41 �4 c-- P11 tff?— 961Z 1�
Street Address Street Address:
K 19 V WG4 ex-a-D. 00
City State zip
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Telephone: 6�-O
til Addr ion
Email address (optional): AWN IAAMMI PJC3,�
f
tirrutim i iva 03
Critical Areas Checklist.doe/4.22.2003