SECTION 1 CLEARING /GRADING PERMIT APPLICATION:
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1 PLEASE REFER TO THE CLEARING & GRADING PERMIT CHECKLIST BELOW FOR SUBMITTAL REQUIREMENTS. SECTION 1 CLEARING /GRADING PERMIT APPLICATION: PROJECT ADDRESS (Street, Suite #): Parcel(s) #: Total Site Area (property size): APPLICANT NAME: Phone #: Address (Street, City, State, Zip): Address: PROPERTY OWNER NAME: Phone #: Address (Street, City, State, Zip): Address: CONTACT PERSON NAME: Phone #: Address (Street, City, State, Zip): Address: CONTRACTOR:* Phone #: Address (Street, City, State, Zip): Address: *All Contractors & Subcontractors must have a valid City of Anacortes business license prior to doing work in the City. Contact the City s Finance Department at (60) Professional License #: Exp. Date: Professional License #: Exp. Date: Are there critical areas (wetlands, streams, steep slopes, etc.) in the project vicinity? Yes No Total area of land-disturbing activity: Will project involve tree removal? Yes No SQ Grading quantities: Cut CY; Fill CY; TOTAL CY Description of location and route to disposal site for excavated material (if to be wasted off-site): Signature: I declare under penalty of perjury that the information I have provided on this form/application is true, correct, and complete, and that I am the property owner or duly authorized agent of the property owner to submit a permit application to the City of Anacortes. Print Name: Signature: Owner Agent Other Date: Page 1 of 8
2 Office Use Only: Clearing / Grading Permit: Applicant Checklist: PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT SECTION 2 CLEARING /GRADING PERMIT APPLICATION CHECKLIST: CLEARING / GRADING APPLICATION SUBMITTAL REQUIREMENTS: The number indicates the number of copies for submittal (if applicable). Application Fees (see Land Use Permit Fee Schedule) Clearing / Grading Permit Application (See Section 1 Above) Impervious /Hard Surface Worksheet (see Section below) Determination of applicable minimum requirements per the adopted Stormwater Management Manual for Western Washington (see Section 4) Construction Stormwater Pollution Prevention Plan (Construction SWPPP) and construction sediment transport potential worksheet. (see Section 5) Site Plan (see Section 6), which may include elements of the SWPPP Cross Section Plan (show dimensions of original and proposed grading; see sample drawing) Arborist Report - inquire with PCED to determine if required State Environmental Policy Act (SEPA) Checklist (Required only if > 500 cubic yards OR if any work on land covered by water) Critical Area Report (wetlands, FWHCAs, streams, geologically hazardous areas, frequently flooded areas, etc.) inquire with PCED to determine if required Copy of Forest Practices permit (FPA) issued by DNR, if applicable 1 Page 2 of 8
3 SECTION IMPERVIOUS SURFACE WORKSHEET: TYPE OF IMPERVIOUS OR HARD SURFACE: EXISTING SQ : PROPOSED REPLACED SQ : PROPOSED NEW SQ : SUBTOTAL OF NEW + REPLACED (SQ. FT.): House + attached garage roof area: Detached structure(s) roof area: Parking area(s): Patio(s): Driveway(s): Sidewalk(s): Permeable pavement or vegetated roof (hard surface): Other: TOTAL: Page of 8
4 SECTION 4 CLEARING/GRADING PERMIT APPLICATION SITE PLAN CHECKLIST: 1. All site plans must be clearly and accurately drawn on 8 ½ x 11 (letter) or 11 x 17 (tabloid) paper. If you need more space you may logically divide your site and draw each portion on a different page, or use layers. etc.) scale. 2. Draw plans to a standard engineering scale (i.e., 1 =10, 1 =20, etc.). List the graphic scale used.. Title block: Include landowner name(s), parcel number, & site address. 4. Provide a north arrow. 5. Property boundaries (from a recorded survey), lot dimensions, property corner locations, & adjoining street name(s). 6. All public and private easements (e.g. utility, drainage, access, etc.). 7. Location, dimensions, and distances to property line of all existing and proposed structures, drainfields, septic tanks, and wells. Additionally show zoning setback lines. 8. Location of driveways (existing and proposed). 9. List lot size square footage & acreage; provide impervious surface calculations (existing and proposed). 10. Location and type of utilities (existing & proposed), connection to the sanitary-sewer, storm-water, and potable water service. 11. Location, type and size of existing significant trees (deciduous and evergreen trees greater than 6 inches in diameter at five feet above grade) and native vegetation; show location of clearing limits. 12. Provide corner elevations of the site & lot topography of existing & proposed grading (drawn at either 2 or 5 foot contours). Use contour lines or arrows to show direction and percent (%) slope(s). Identify any erosion or landslide areas as well as any potential unstable slopes greater than 15%. (Percentage % slope = Rise (drop in height) divided by Run (distance) multiplied by 100. Show contours extending onto adjacent properties and proposed transitions. 1. Location of critical areas and buffers (i.e., streams /creeks, wetlands, and geologically hazardous areas/ steep slopes) that are either on the subject property or within 00 feet of it include a critical area report if applicable. 14. Location of adjacent marine or freshwater shoreline, bulkhead, ordinary high water mark (OHWM) and setback. A shoreline exemption may be required inquire with PCED. 15. Stormwater management: Show appropriate elements of the Construction SWPPP, including: a. Areas of vegetation to be preserved; clearing limits b. Drainage ditches and swales (existing/proposed) c. Construction access d. Temporary and permanent stormwater retention or detention facilities; sediment and erosion controls; slope protection, etc. e. Infiltration systems (existing/proposed) See the Stormwater Management Requirements handout for other requirements. Page 4 of 8
5 SECTION 5 DETERMINATION OF STORMWATER MANAGEMENT MINIMUM REQUIREMENTS: Page 5 of 8
6 SECTION 5, CONTINUED: Page 6 of 8
7 SECTION 6, CLEARING /GRADING PERMIT APPLICATION ADDITIONAL INFORMATION: BACKGROUND: A clearing and grading permit may be necessary whenever clearing (destruction and removal of vegetation) or grading (excavation or filling) is being done in the City of Anacortes. Appendix J of the International Building Code (IBC) sets forth rules and regulations to control excavation, grading, and earth work construction including fills and embankments, establishes the administrative procedure for issuance of permits and provides for approval of plans and inspection of grading construction. Anacortes Municipal Code (AMC) also provides regulations for clearing and grading of property, and AMC identifies how stormwater must be addressed. DEFINITIONS: Impervious surface means a non-vegetated surface area which either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A nonvegetated surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to, roof tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. Open, uncovered retention/detention facilities shall not be considered as impervious surfaces for the purposes of determining whether the thresholds for application of minimum requirements are exceeded. Open, uncovered retention/detention facilities shall be considered impervious surfaces for purposes of runoff modeling. AMC Hard surface means an impervious surface, a permeable pavement, or a vegetated roof. AMC Land disturbing activity means any activity that results in a change in the existing soil cover (both vegetative and non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling, and excavation. Compaction that is associated with stabilization of structures and road construction shall also be considered a land disturbing activity. Vegetation maintenance practices, including landscape maintenance and gardening, are not considered land-disturbing activity. Stormwater facility maintenance is not considered land disturbing activity if conducted according to established standards and procedures. AMC Additional applicable definitions and regulations can be found in the Anacortes Municipal Code and the Department of Ecology 2012 Stormwater Management Manual for Western Washington. Page 7 of 8
8 TREE REMOVAL AND FOREST PRACTICES: Fill and grading activities are commonly associated with logging activities. Individuals wishing to remove trees from their property should first contact the Department of Natural Resources (DNR) at to determine if a Forest Practice Application (FPA) is required. NOTE: The preceding information is provided in summary and does not take the place of full text of the adopted regulations in the Anacortes Municipal Code. Please contact City of Anacortes Planning, Community & Economic Development Department staff if you have questions or need assistance. Page 8 of 8
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