HomeMy WebLinkAboutRLC93-00221 - RLC Application Date Received: "�7
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT ?A,
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST 10��
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 development.
identifying e r yin the permit process whether there will be any environmental regulations affecting
the proposed development.
Owner GNAi_i, N,419/ty ;r Phone #0J4 ) Z?S-4,0f a
Site Address F. (4371 Hwti .3 City A 11,M Zip_ 2�
Owner Address__ ,D , l3oX '<_70 City 4 AddEviF,✓ StatekA Zip `ler�/(,
Tax Parcel No. (Confirm with Assessors Office) 12 z 3 ) - 1 -_ U-p (0 Legal Description
AZ rAmct> 1� 31 14 9 0U 1
Project Description Ce,usT►2uc7,1of/ or ®tiFjcE �ryg,2F�IvNrF )/L STxFTr-y
Directions to site (Please attach map) Angars r cm mtt. e47 off /4w_1
—b9f hltE ,j'oN?H 01= Att`1N
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 areas
Official and resource lands are available for review at Mason County Department of Community Development, Planning
Use only 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?
❑ ❑ M 2. Rivers, streams, or creeks with year-round flow? 0
❑ 21 ❑ 3. Rivers, streams or creeks with intermittent flow b t are within adefine channel? �},�
2UNd r+r SNOW14 OAt r/re h4y'.d. AA
'i ❑ ❑ ® 4. Lakes or ponds less than 20 acres in size? 4*�1
❑ [R ❑ 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstances
support vegetation adapted f r life in such
conditions; uch as��rshes, bogs, and swamps. (See, County
Maps for guidance.) �V ' .lkAAA 1� 6atlkl
❑ ❑ ® 6. greater 1 Slopes than +%P 9 � (8.5 degrees)? (See the County Landslide and rosion Hazard Map4 for
guidance.)
❑ ❑ R1 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.) 0
❑ ❑ R) 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.) yl") ,
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
a of the following programs:
County Yes No
❑ ❑ ® 1. Agricultural Open Space Taxation Program, RCW 84.33
❑ ❑ 21 2. Open Space Timber Taxation Program, RCW 84.33, or Designated Forest or Classified Forest,
? RCW 84.34
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County Department of Community Development for MOO each
RESOURCE LANDS & CRITICAL AREAS
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.
► Identify legal access Including,width of all road right-of-ways&easements. P. Location of significant natural features(water bodies, rivers).
P. Locate all existing &proposed structures,drainfields, wells &driveways. P. Project description
Scale 1"= North Arrow
S rrE 17G04 A T'fAC.N D
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I state that I have answered the above truthfully to the best of my knowledge.
Applicant/Owner �c�i �� 913 Date
FOR OFFICIAL USE ONLY
Adjacent property.
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1 There is 540.00 pplication fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Mason
County T nC—
Whe completed, t'
! n mpl tad, this form becomes part of the permit application.
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