HomeMy WebLinkAboutRLC94-0375 - RLC Application - 3/4/1994 MASON COUNTY Date Received:Wq* b ?7 Q
DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST no
The following checklist is designed to assist an applicant for a Building Permit, On-Site Sewage System Site
Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Line Adjustments, Land
Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affected by
regulations under the Mason County Interim Resource Ordinance (77-93)*. This checklist is an important
opportunity for identifying early in the permit process whether there wi//be any e�nvironmen,a/regulations affecting
the proposed development. ( A���� fr,�,l^��-1,�i,�/ U�%"C'L�';��t �°'
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Owner I�cA/ ay-I� Phone #(Zo6 ) 777 - 610S
Site Address g- v,'cw loon R� City �ll�h Zip
Owner Address _I90os L.4Tk .4uE <E City hwaod StatemlA_Zip ggo3"
Tax Parcel No. (Confirm with Assessors Office) %-ZZ-z 9 - yZ - n a o p t/o Legal Description_
Project Description_ S, eff'f Fan,,'�v l�C C.
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Directions to site (Please attachrap). Vr-am
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Please provide or attach a vicinity map which in ss s reets, rror roads ycreeks, tc.
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Answer the following to the best of your knowledge. County-wide maps show g g neral locations of critical areas
ofnow and resource.lands are available for review at Mason County Department of Community Development, Planning
u"omy Department.
Do any of the following exist on this property or within 200 feet of this property?
C Yew No
❑ 1. Saltwater shoreline or a lake 20 acres or larger? qZ10
[I Er 2. Rivers, streams, or creeks with year-round flown T l c�c .s c rcc/C ✓l orF s c�r
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❑ 3. Rivers, streams or creeks with intermittent flow but are qM
a clearly defined channel?
El El4. Lakes or ponds less than 20 acres in size?
4
❑ 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstances
support vegetation adapted for life in_suc4 conditi s;such as marsheq, bogs, and swamps. (See County
Maps for guidance.)
❑ 0 6. Slopes greater than 15 (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps f r
guidance.) 3o .�
[� ❑ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
/ for guidance.)
�] ❑ 0 S. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.) vt V
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
County Yes No
❑ ❑ i� 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.
KtSUUKCa 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,drainf gilds, wells &driveways. P. Project description
Scale 1"= So. North Arrow
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I state that I have answered the above truthfully best of my knowledge.
Applicant/Own Date
FOR OFFICIAL USE ONLY
Adjacent property
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There is a $40.00 application fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Mason
County Treasurer.
When completed, this form becomes part of the permit application.