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Home My WebLink AboutRLC94-0836 Eagle Territory - RLC Inspections EA6L_ Data Received: � -• ` � MASON COUNTY A ,OMDEPARTMENT1 /�� ' OF COMMUNITY DEVELOPMENT ��61 ( qRESOURCE LANDS AND CRITICAL AREAS CHECKLIST 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 l Adjustments, Land Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their prc erty is affected by regulations under the Mason County Interim Resource Ordinance (77-93)•. This check fist is an important opportunity foridentifying earlvin the permit process whether there will be any environmental regulations affecting the proposed development. Owner C 0r(-Q` Phone u ao Y aro — S 71 Site Address t " P C,K-0 City U v\ Z-3 Zip C? Owner Address b. &Y, 5({9 1Q',,V O is City S'SLu C-I-av,, Stat / Zip 92 8�! i C - 9ao � t Tax Parcel No. (Confirm with Assessors Office) �_ ns - gal Description_ Project Descri tion w� Directions 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 loc tions of critical areas Ofwa and resource lands are available for review at Mason County Department of Community Deve opment, Planning u..omy Department. Do any of the following exist on this property or within 200 feet of this property? C—amv Ye. N. ❑ ❑ ® 1. Saltwater shoreline or a lake 20 acres or larger? ❑ 2. Rivers, streams, or creeks with year-round flow? f\ ❑ ❑ ® 3. Rivers, streams or creeks with intermittent flow but are w't in a clearly defined channel? ❑ ❑ (;J 4. Lakes or ponds less than 20 acres in size? n 1 ❑ 5. Wetlands: Areas that are inundated or saturated by surface water that under i lormal circumstances support vegetation adapted for life in such conditions; such as marshes, bogs, and swamps. (See County Maps for guidance.) ❑ ❑ I,a 6. Slopes greater than 15% (8..55 degrees)? (See the County Landslide and Ero ion Hazard Maps for guidance.)qD D6% /y/nn0 f o UAW '' (C-, #I,nfe at A 10 ❑ El ® 7. Floodplains? (Sae County Federa, Emergency✓Maanageement: Maps and ou y Seismic HazardJM.p for guidance.) ❑ ❑ ® 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 y u are enrolled in any of the following programs: Ce V YM N. El ET-D 1. Agricultural Open Space Taxation Program, RCW 84.33 ❑ ❑ ® 2. Open Space Timber Taxation Program, RCW 84.33, or Designated Forest or Cis sified Forest, RCW 84.34 • Copies are available at Mason County Department of Community Development for 65.00 each. _ RESOURCE LANDS & CRITICAL AREAS SITE PLAN PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE: " Location&dimenalons of existing &proposed property boundaries. s Approximate slope of lend (grade &direction' topography. s Identify legal access Including,width of all road right-of-ways&easements. " Location of significant natural features Iwate bodies, rivers). " Locate all existing &proposed structures,drainfields, wells &driveways. " Project description Scale 1"= Not th Arrow — I state that I have answer, the above tr thfully to the best of my knowledge. Applicant/Owner `F / S Date FOR OFFICIAL USE ONLY Adjacent property. 9�� C1-1V/11' �j , ,Z�;»� YJsT�4Frtg;`�$�O�,{S�t�n,�y�g((RMesg41rC051,an11 IIE18lP$,��tlais property is (fesip[lat0dras3`� �` �'� �s¢ '�Y` a � ` \ a;Li;�`�3,�� J�,K.ong term Cor�merafal;�tQre$1:C� F a¢sF o�`` 3.. �: FFS�areline�Maser Pr ram 1$ S;. $ tlholding Land $3G9 iJ.f. k4�w V'.,5.� S V{y"Dq �f1gt8 i d�' L 3. fo•o$'s'i� n S��CxJ?�N::.) ,MItlBtal'Reso[1tt:$jL hd u c F'�r>r yss^JJ:.JiJ;Joo•,<,`. $ a .« r y¢ r k >"s=';; s'�< ��,, taxs„� ;tsgs L.. �, �r. ¢ .�3(rYs(F'z;r<.>'riYq w.sj.Y�<3:'.r,� '.I$. s�SFL nF 3•r.;Ha F 3¢;E.u?%d:.o S<soggc'S">ys:<J M) �e sw..,:ga s'o2,...:'�' isa s s ri��"as"`b'53'k¢ f ; £... a3r 9', ; a ... DCD .e There is a $40.00 application fee for the Resource Land & Critical Areas Checklist Make checks pi yable to the Mason County Treasurer. When completed, this form becomes part of the permit application. S oN..STA GARY YANDO,DIRECTOR pT�cO� S O u DEPARTMENT OF COMMUNITY DEVELOPMENT N T ai PLANNING - SOLID WASTE - UTILITIES �0 Y �oY BLDG. I • 411 N. 5TM ST. • P.O. BOX 578 1664 SHELTON, WA 98584 • (360) 427-9670 DISCLAIMER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD, LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PER The undersigned property owner is aware.of the uncertainty regarding Mason County'e development regulation fed by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Maso County's willingness to proceed with processing of applications which might be affected by that Order, the undersignol property owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may a ise out of Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter" >ermitting actions permitting P s '�, which damages are attributable to the County's decision to take rmittin actions despite the risk t t changes to the County's development regulations might later make the County's permitting actions invalid. Date (Parcel No:or Legal Description) Property owner's signature(Notarized) (or the County may accept the signature of the owner's authorized agent upon proper proof of authorization) ACKNOWLEDGEMENT CERTIFICATE (INDIVIDUAL) STATE OF COUNTY OF On this _day of , in the Year_, before me Notary Public, personally appeared Personally known to me to be the person whose nart a is subscribed to this instrument, and acknowledged that he/she executed it. WITNESS my hand and official seal. -For County use o ily - �1-2 11r.11��( • Reviewe by li on Gli Notary's signature le) My Commission Expires: U Staff Initial: GARY YA 4DO,DIRECTOR ?yiON-_STATFO� "'o DEPARTMENT OF COMMUNITY DEVELOPMENT S N = PLANNING -SOLID WASTE- UTILITIES 7 NY 4 BLDG. I • 411 N. 5' ST. • P.O. BOX 578 o SHELTON, WA 98584 • (360) 427-9670 1864. DISCLA % ER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD, LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERMITS: The undersigned property owner is aware of the uncertainty regarding Mason County's development regulatiow created by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of MasonCounty's willingness to proceed with processing of applications which might be affected by that Order, the undersigned roperty owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may ari a out of Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter"Ix rmitting actions'), which damages are attributable to the County's decision to take permitting actions despite the risk that changes to the County's development regulations might later make the County's permitting actions invalid. a 1 0'S j (e 1 U 0 71 Date (Parcel No. or Legal Descrip(ion) �-1 \ S Q!� � �tQ f✓ Property er's signature(Notarized) (or the County may accept the signature of the owner's authorized agent upon proper proof of authorization) ACKNOWLEDGEMENT CERTIFICATE (INDIVIDUAL) STATE OF COUNTY OF On this _day of , in the year_, before me Notary blic, personally appeared personally known to me to be the person whose nadio is subscribed to (his instrument, and acknowledged that he/she executed it. WITNESS my hand and official seal. - For County use only - Reviewed by appli I on (Date) Notary's signature Staff Initial: My Commission Expires: GARY YA DO,DIRECTOR PyON._STA- M o DEPARTMENT OF COMMUNITY DEVELOP ENT AU x N PLANNING - SOLID WASTE - UTILITIES N Y Y" BLDG. I a 411 N. 5' ST. a P.O. BOX 578 SHELTON, WA 98584 • (360) 427-9670 1864, DISCLABAER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD, LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERU TS: The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Mason ounty's willingness to proceed with processing of applications which might be affected by that Order, (be undersigned property owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may ari a out of Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter" rmitting actions"), which damages are aunbutable to the County's decision to lake permitting actions despite the risk that changes to the County's development regulations might later make the County's permitting actions invalid. Date (Parcel No. or Legal Description) Property er's signature(Notarized) (or the County may accept the signature of the owner's authorized agent upon proper proof of authorization) ACKNOWLEDGEMENT CERTIFICATE (INDIVIDUAL) STATE OF COUNTY OF Oa this _day of , in the year_, before me Notary I ublic. personally appeared personally known to me to be the person whose n&r ke is subscribed to this instrument, and acknowledged that hc/she executed it. WITNESS my hand and official seal. For County use n(y Reviewed by appli on (Date) Notary's signature Staff Initial: My Commission Expires: