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HETLAND LAND USE NOTIFICATION FORM <br />DIVISION OF STATE LANDS WETLANDS PROGRAM <br />??5 Summer Street NE, Salem, Oregon g?310 <br />503/378-380S <br /> <br />County: Marion <br />City: Au~sville <br /> <br />APPLICANT: ~S~ven Busby <br /> name <br /> 6743 Sh~ Hwy <br /> <br /> ALU~5~ill~ or~e~o~ 9732~ <br />city state <br /> <br />phone <br /> <br />Local Case File No.: <br />DSL File No.: <br /> <br /> LANDOWNER: Steven Busbv <br /> name <br /> 6743 Shaw Hw7 <br /> street <br /> Aumsvillew Oregon 97325 <br />zip city state zip <br /> (.50~ 749-2794 <br /> <br />phone <br /> <br />LOO~TION: <br />7 Ss R 2w S 25 l/4 __ lax Lot(s) 57757-000 <br />NWI quad map name North Santiam River=Sta~t~On(attach copy with site indicated) <br />Attached: x NNI map Parcel map x Site plan __ Other <br /> <br />SITE iNFORMATION: <br />NNI Wetland Classification Code(s) PP~c~ ..................................... <br />Soil Series Name (optional) <br />Adjacent Waterway (if any). In Floodplain? Y __ N × <br />Current Land Use Garage Structure--remaining empty Zoning Residential M~lti-Family <br /> area. <br /> <br />PROPOSED ACTIVITY: <br />__ site plan approval <br />___ grading permit <br />.... conditional use permit <br /> × buildi~ permit <br />.... Zone Change to: <br />Pro~ect Description: <br /> <br /> subdivision <br />__ planned unit development <br /> public works (specj.fj) <br /> other <br /> <br />Construction of a New Single Family Dwelling w/o garage <br /> <br />Completed by/Contact: ~l-L~nb~th M.~ Date ~/SYP3 ._ <br />Address w,o. ?~w 277- A~Tn~'~O~ 97325 -- Phone 749-203~) <br /> <br /> removal~fill permit is required from the Division of State Lands. <br /> removal-fill permit will be required when the development pro~ect proceeds. <br /> removal-fill permit may be required. <br />information needed includes: <br /> A wetland determination/delineation report. <br /> <br />State permit __ [2] was issued ~ has been applied for, <br />No removal~fill permit is required for the described pro~ect if/because: <br /> <br />[--1 A permit may be required by the Corps of Engineers (326-6995) <br />Comments: <br /> <br />Response completed by: Date <br />* If the project is changed to involve flll or removal from the wetlands area, a <br />state removal-fill permit will be required, <br /> <br /> <br />