HomeMy WebLinkAboutRLC94-00950 - RLC Inspections - 4/27/1994 Y • Date Received: t ' ? - Q
MASON COUNTY
DEPARTMENT OF COMM UNITYbEVELOPMENT�Y-Et WAIVgp
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RESOURCE LANDS AND CRITICAL AREAS CHECKLIST
The following checklist is designed to assist an applicant for a Building Permit, On-Site Sewage System 5
Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Line Adjustments, La
Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affected
regulations under the Mason County interim Resource Ordinance (77-93)*. This checklist is an impofti
opportunity for identifying gar/vin the permit process whether there will be any environmental regulations affects
the proposed development.
Owner M<-V- S+eve Phone #(;�n6 ) a�5-54
Site Address NE c14 `1`f 3 �'(vtJ�r 3 City-Bp (�.Z r Zip 4�5�
Owner Addresson
�d, `3 bx lil�'I City. R I _Y State.LL2rZip G5 28_
Tax Parcel No. (Confirm with Assessors Office) -:k:l _p 00 1(0 Legal Description_
i= aTyMz 6^-r '0 c'sc
Project Description Pg Ca A2nra x SO r�0y ��! ,1
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Directions to site (Please attach map) SEE' A 2f4,Z/--j" /W g—Q
Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc.
1
Answer the following to the best of your knowledge. County,-wide maps showing general locations of critical ar(
WNW and resource lands are available for review at Mason County Department of Community Development, Planning
use oray Department.
Do any of the following exist on this property or within 200 feet of this property?
County❑ yes—❑ No
1. Saltwater shoreline or a lake 20 acres or larger?
❑ ❑ ( 2. Rivers, streams, or creeks with year-round flow?
❑ ❑ El 3. Rivers, streams or creeks with intermittent flow but are within a clearly defined channel?
❑ ❑ 4. Lakes or ponds less than 20 acres in size?
❑ ❑ 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstanc
support vegetation adapted for life in such conditions; such as marshes, bogs, and swamps. (See Cour
Maps for guidance.)
❑ ❑ ® 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps
guidance.)
❑ ❑ ( 7. Fioodplains? (See County Federal Emergency Management Maps and County Seismic Hazard V.
for guidance.)
❑ ❑ ® 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seisr
Hazard Map for guidance.)
You may be provided nuisance protections by the County for certain resource activities, if you are enrolled in a
of the following programs:
ount Yes No
❑ [] �] 1. Agricultural Open Space Taxation Program, RCW 84.33
❑ ❑ ® 2. Open Space Timber Taxation Program, RCW 84.33, or Designated Forest or Classified Forest,
RCW 84.34
' Copies are available at Mason County Department of Community Development for $5.00 each.
' 1'tt_uVVhVG LHIMVJ CX 1rh111trHL HhCHa7
r SITE PLAN
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP' IF POSSIBLE:
P. Location&dimensions of existing &proposed property boundaries. ► Approximate slope of land(grade &direction),topography,
r Identify legal access including,width of all road right-of-ways&easements. . Location of significant natural features(water bodies, rivers).
► Looate all existing &proposed structures,drainfleids,wells &driveways. ► Project description
Scale 1"= North Arrow
5C A IT lox P�o� 11A �
I state that I have answered the above truthfully to the best of my knowledg
�'7t�lL ���"^�✓� Applicant/OwnQL
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FOR OFFICIAL USE ONLY
Adjacent property.
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There Is a $40.0 applicatlon fee for the Resource Land & Crf cal Areas Checklist. Make checks payable to the Masc
County Treasurer,
When completed, this form becomes part of the permit application,
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