Land Alteration and Drainage Ordinance

Applicability Questionnaire

Please complete this Questionnaire to determine if the Land Alteration and Drainage Ordinance No. 1,
applies to your development activity.
Application No.:_________________________

Property ID No.:_________________________
Landowner:

 Applicant:
Address:

 Address:
City, State and Zip:

 City, State and Zip:
Telephone Number:

 Telephone Number:
Legal Description of the Property:

Property or Street Address:

Plat Name:

Division: Block: Lot(s):

Please answer the following questions:

Is the activity located within the Flood Control Zone District No. 1?    Yes    No    Account No.

Is the activity a Single-family, Duplex Residence or related?             Yes    No    

        If "No", please specify type:

1.    Does the activity involve clearing, grading, filling, excavation, paving or surfacing?    Yes     No

2.    Will the activity involve Clearing and Grading of more than 5,000 square feet?            Yes    No

        Amount of Clearing/Grading: Square Feet

3.    Will the activity involve Landscaping, Yard Maintenance, or Gardening or more than 7,500 square feet?    Yes    No

        Please specify amount: Square Feet

4.    Will activity involve placing fill material?      Yes     No

        (If Yes, please answer the following questions.  If No, go to Question 5.)

        A.    Will fill material exceed one (1) foot in depth?    Yes    No     Depth: Feet

        B.    Will fill material exceed 50 cubic yards?    Yes    No    Amount of Fill: Cubic Yards

        C.    Will fill material be placed near or within a drainage way (ditch, swale, channel, etc.)?    Yes    No

        D.    Has property even been partially or completely covered with water?    Yes    No

5.    Will the activity involve the removal of earth (excavation) exceeding two (2) feet in depth?    Yes    No

        Depth of excavation: Feet.

6.    Will the activity involve slopes of greater than 20%?     Yes    No    Specify slope: %

7.    Will the activity alter a man-made or natural drainage features (swales, ditches, canal, streams, lakes, etc.)?    Yes    No

8.    Will an existing building be modified?    Yes    No

        (If Yes, please answer the following questions.  If No, go to Question 9.)

        A.    Will the modification increase the existing building footprint by 25% or more?    Yes    No    Amount %

        B.    Will the modification increase the existing impervious area (pavement, roofs, walks, driveways, etc) by 25% or more?

                Yes    No    Amount %

        C.    Will the modification add more than 5,000 square feet of impervious surface area?    Yes    No    Amount %

        D.    Will stormwater be discharged from the site?    Yes     No

9.    Will the activity create or add more than the following amounts of impervious surface:

        A.    For Road projects (only):        10,000 square feet         Yes     No

        B.    For all other projects:                 5,000 square feet        Yes    No

10.    Will the activity be located adjacent to a man-made or natural drainage feature (including streams, canals, pond, lake, wetland, closed depression, etc.)?        Yes    No

11.    Has DCD determined whether the activity is located within a critical area, as defined by the Critical Areas and Resource Lands (CARL) ordinance (No. 147)?    Yes     No

If the answer to any of the above questions 1 through 11 is "yes", the development activity may be subject to the Land Alteration and Drainage Ordinance.   Please submit a completed Land Alteration and Drainage Permit Application for further review.

I hereby certify under the penalty of perjury of the laws of the State of Washington, the above information contained in this application is true, complete, and accurate to the best of knowledge and belief.  I understand any revision to the aforementioned activity will require completion of a new Questionnaire and as a result of findings, may require submittal of a Land Alteration and Drainage Permit Application.   I also hereby authorize access to the above mentioned property for purposes of observation by the Administrator and/or his designee.

 

Owner Signature:__________________________________   Date:___________________

  

Do Not Write Below This Line - For County Use Only

Activity is exempt from FCZD No. 1, Ordinance No. 1        Rev'd__________        Date:____________

Activity is subject to FCZD No. 1, Ordinance No. 1

        Land Alteration Permit Required                                     Rev'd__________         Date:____________

        Drainage Permit Required    Abbreviated Plan           Rev'd__________         Date:____________

                                                           Full Drainage Review     Rev'd__________         Date:____________