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Home My WebLink AboutRLC94-1155 - RLC Application - 5/24/1994aR Date Received: , MASON COUNTY r DEPARTMENT OF COMMUNITY DEVELOPMENT T S � FQ ®NDS AND Rlrlr+w� ,iSE S�CHE KI leer The following ch"41ht is .designed to assist an applicant for a Bui/din Eveluat/on and DlSpo8ai Permit, Access Permit, Land ModiRcadon Permit inn en� e sewage system segregations, HaZardous Waste Permit, or Shoreline Permit in determining whether their ry Line Adjustments, L, regufetIons under the Mason County Interim Resource Ordinance (77-93!'. Thls Checklist is affectea opportunity forldentifyingltYin thepermitprocess whether there wi//bean enviro �kl�st is an import the proposed development. Y nmenta/regulatIons affect Owner (,S i//n tSt 7 Site Address Phone iltl ) 6 - 3%_ Owner Address City Zip�.- .,Tax Par ei No. (Confirm with Assessor Office) �3► city, d State�Zip- 30. j Legal Oescri tion p - Project Description Directions to site (Please attach map) Al Please provide or auach a vicinity map which inc u es cross streets, major roa s, cree Answer the following to the best of your knowledge. County-wide and resource lands are available for review at Mason County epartme a showing Oenerpl locations of critical area u"o,w Department. Development, Planning X'W No Do any of the following exist on this property or within 200 feet of this property? 0-0 1. Saltwater shoreline or a lake 20 acres or larger? ❑ ❑ 2. Rivers, streams, or creeks with year-round flow? ❑ ® ❑ 3. Rivers, streams or creeks with intermittent flo�butare a clear) defined u_ „ �( channel? ® 4. Laces or ponds less than 20 acres in size? +n Il �`� ❑ ❑ � 5• Wetlands: Areas that are inundated or , w support vegetation adapted for life eted b uchasCee�ates that Ounder n nd normal ais circumstances Maps for guidance.) � p (See Co ty ❑ � ❑ 6. Slopes ®rester than 1596 (8.5 degrees)? (See the Coun- guidance.) � tior' rr•,j ,�.R s„s r-o q G6�.c ty Landsi a and rosion Hazard Maps for ❑ ❑ ® 7. Floodplalns? (See County Fe er for guidance.) al Emergency Management Maps and County Seismic Hazard Map ❑ ❑ ® 8• Seismic Hazard Areas? (See County Federal Emergency Management �A Maps and County Seismic Hazard Map for guidance.) You may be provided nuisance protections by the County for certain resource activities. If You of the following programs: y are enrolled in any Xft No ❑ ❑ 1. Agricultural Open Space Taxation Program, RCW 84.33 ❑ • ® 2. Open Space Timber Taxation Program,.RCW 84.33,or Designated Forest or CI RCW 84.34 assiflad Forest, 1�, ' Copies are available at Mason County Department of Community Development for ss.00 each. KI I K;AL AREAS ,. SITE PLAN PLEASte SHOW THE FOLLOWIN© INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE: ►Identify MOM s of erA,Wi 4 proposed property boundaries. ► Approximate atop*of land(grade#direction), � Locaft�existing��.widttr of sd►IpM�of-w�ya&easements. ► topography. Location of algniHcant natural features(water bodies,rives). P�Peaed at�a a+d►aiMlaldt.wMla i driveway*. ► Project description sl gon ale 1"a= F / North Arrow 46 \ s t • t� 1 st hat I have answered the above truthfully to the best of my knowledge. c t APPlicant/Owner at FOR FOR OFFICIAL USE-ONLY scent property„ 4. keAw There Is s S40.00 app6caiion f" for Me Resource Land& Critics/Areas Checklist. Make checks County Treesure�r peyaWe to the Mason When completed, this form becomes part of the pemdt application.