HomeMy WebLinkAboutRLC94-0893 - RLC Application - 4/22/1994 - MASON COUNTY Date Received. 'z Z •Cj 9
DEPARTMENT OF COMMUNITY DEVELOPMENT
• 3 RESOURCE LANDS AND CRITICAL AREAS HE KLIS 7o
The following checklist is designed to assist an applicant for a Building Permit, On-Site Sewage System S
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 importa
opportunity foridentifying e_ arlvin the permit process whether there will be any environmental regulations affecti.
the proposed development.
Owne �` W , �GfIf�9A/`l Phone # - a
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Site Address_ ,� NCO 01001
aep cS,q� Zip
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Owner Address �U /'30�( 3o City �/✓ Stat Zip Z
Tax Parcel No. (Confir with Assessors Office) /Z2 2/ _ �Z _ 0(0 0
_ O Legal ascription_
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Project Description �6 Nb G•�' o G` cS
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Directions to site Pleas _(Please attach map)_ dc1�/ �a�. TD OGi off, /� y/L C_ A�
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Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc.
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Answer the following to the best of your knowledge. County-wide maps showing general locations of critical area,,
Official and resource lands are available for review at Mason County Department of Community Development, Planning
Use orgy Department.
Do any of the following exist on this property or within 200 feet of this property?
Cc Yes N
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 flow but are ithin aAlearly defined channel?
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❑ 4. Lakes or ponds less than 20 acres in size?
L4 ❑ 5. Wetlands: Areas that are inundated or saturated by surface water that under normal
rcumstances
support vegetation adapted for life in such conditions;such as marshes, bogs, and swamps.'(See County
Maps for guidance.)
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ICJ ❑ 6. Slopes greater than 15° (8.5 degrees)) (See the County Landsli a and Erosion Hazard
guidance.)r 41 O�� �S��� � �, m�6 Maps for
lLl ❑ ] 7. Floodplains? (See County Federal Emergenc Management aps and County Seismic Hazard Map
Y� for guidance.) (/I,
❑ 8. Seismic Hazard Areas? (S County Federal Emer en
Hazard Map for guidance.) 9 cY Management Maps and County Seismic
i
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
C t Yes N
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❑ 1. Agricultural Open Space Taxation Program, RCW 84.33
- ❑ 2. Open Space p p 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.
RESIJURCE LANDS & CRITICAL AREAS
SITE PLAN
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
► Location&dimensions of existing &proposed property boundaries. ► Approximate slope of land (grade &direction),topography.
► Identify legal access including,width of all road right-of-ways&easements. ► Location of significant natural features(water bodies,rivers).
► Locate all existing &proposed structures,drainflelds, wells &driveways. ► Project description
Scale 1"= Zoe North Arrow
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1 state hat I have answered the above truthfully to the best of my knowledge.
`j Applicant/Owner Z� Dab
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`j FOR OFFICIAL USE ONLY
Adj nt property.
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There is p $40.00 application fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Maso
County Treasurer.
'k When completed,this form becomes part of the permit application.
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