HomeMy WebLinkAboutRLC94-1138 Cancelled - RLC Application Date Received:_' "in ZZ' �4
MASON COUNTY
70 DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOLUE.LANDS AlIID G CAL.AR B., 'i� =K� IST
wing checklist Is designed to assist an applicant for a Building Permit, On-Site Sewage System Site
A,bn and Disposal Permit, Access Permit, Land Modification Permit, Boundary Llnq.gdf pftrpents, Land
' legation, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affected by
lula*ns under the Mason County Interim Resource Ordinance f77.93i'. This checklist is an Important
bportVilky forldentifying evikin thepermit process whether there will be any environmental regulations affecting
the prtosed development.
Owner M N��/MA� Phone N ` 1*7-57po
Site Adt ass 49'L/l/ GfZD11IQJlcf- City QLL WA Owner-Address City Statekk-Zipggiglty
Tax Parcel No. (Confirm with Assessors Office) /ZZ32 _ ! _ d�j$`� Legal Description_
Project Description 1G&AO O fi hol— o-A
Directiins to site (Please attach map)
Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc.
Answer the following to the best of your knowledge. County-wide maps showing general locations of critical areas
offwr and resource lands are available for review at Mason County Department of Community Development, Planning
u060* Department.
r Do any 9t,the following exist on this property or within 200 feet of,this
property?
Ly 1. Saltwater shoreline or a lake 20 acres or larger? /V
❑ 2. Rivers, streams, or creeks with year-round flow? y W
d 3. Rivers, streams or creeks with intermittent flow but are within a cl a defined channel?
❑ 4. Lakes or ponds less than 20 acres in size?
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I ❑ 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstances
support vegetation adapte4 for life in such conditions;such as marshes, bogs,and swamps. (See County
Maps for guidance.)
❑ QV 6. Slopes greater than 15% (8.5 degrees)? (See the County Lan slide and Erosion Hazard Maps for
guidance.) p
UG�JI-wt..�L
97. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.) LAJO
❑ 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.)
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
[� 1. Agricultural Open Space Taxation Program, RCW 84.33
2. Open Space Timber Taxation Program,RCW 84.33,or Designated ForWiwAftsified Forest,
RCW 84.34
' Copies are available at Mason County Department of Community Development for 45.00 each.
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RESOURCE LANDS& CRITICAL AREAS
SITE PLAN
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
D. Location&dimensions of existing &proposed property boundaries. ► Approximate stops of land (grade&direction),topography.►Identify legal access hviudkp,width of ON road right-of-ways&easements. ► Location of significant natural features(water bodices,Vis).
► Locate all existing &proposed structures,drainfields, wells &driveways. ► Project description
Scale 1"
North Arrow
state that 1 to the best of my knowledge.
Applicant/Owner , "7 9 Date
FOR OFFICIAL USE ONLY
cQacent property.
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Thane is a #40..00 application fee f" the Resource Land & Critical Areas CheckQst Make checks payable to the Mason
County Trehstrrar.
When completed,this form becomes part of the permit application.
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84 -22 847- 207 622- 99