HomeMy WebLinkAboutRLC94-0068 - RLC Inspections - 1/13/1994 Date Rece'ved:
MASON COUNTY'
z - DEPARTMENT OF COMMUNITY DEVELOPMENT
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RESOURCE LANDS AND CRITICAL AREAS CHECKLIST XF9Z9X=W
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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 foridentifying earlyin the permit process whether there wyll be any environmental regulations affecting
the proposed development.
Owner K i IL✓, mig 5mL(Lt;� h,,'yf- (l,S F r•1 Phone #( 2o(e ) .4 ZG -3oSz-
Site Address APPL_1)`.p City Zip
Owner Address 1�,Ll�6S1 S�)rc.rooJ p4->kTt-c,cK. R,,4p C�ty_5HL-(-roPj State t,/LZip U Uq
Tax Parcel No. (Confirm with Assessors Office) qZ b a - 91T- 0000 Legal Description_
o P- PL-A- ZZ Lt i-0 0 8-s- !a-( Zo o is o
Project Description C,,nhi s c.,- 1 0 Nc.L.
Directions to site (P -map) oAyr&ti vL 4 iL--,r 0 c_o PeN s- o 0
0 qt G-'o To f r I , rt 2 i C,r
W. 0 f -`'ED rJ D RI i 42 0 ram/ c, nl
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
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? Y`j
❑ ® 2. Rivers, streams, or creeks with year-round flow? j
] ❑ [� 3. Rivers, streams or creeks with intermittent flow but are within a clearly defined channel?
Jn ❑ [K 4. Lakes or ponds less than 20 acres in size?
[L� ❑ (�J 5. Wetlands: Areas that are inun aced or saturated by surface water that under normal circumstances
t support vegetation adapted for life in such conditions; such as marshes, bogs, and swamps. (See County
Maps for guidance.)
a
❑ 6. Slopes greater than 15% (8.5 degreesj? (See,the County Ldndslide and Erosion Hazard Maps for
guidance.) Y.
❑ ® 7. Floodplains? (See l ounty Federal Emergency Mana ementd Maps and County Seismic Hard Map
for guidance.) All,V, It
8'
❑ []K 8. Seismic Hazard Areas? (&ee 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:
Collinty Yea No
❑ ® 1. Agricultural Open Space Taxation Program, RCW 8433
(� ❑ 5d 2. Open Space Timber Taxation Program, RCW 84.33, or Designated Forest or Classified Forest, u �
RCW 84.34
* Copies are available at Mason County Department of Community Development for $5.00 each.
:RESOURCE LANDS & CRIT16AL AREAS
- ' SITE PLAN
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY M P 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,drainfields, wells &driveways. ► Project description
Scale 1"-- North Arrow
I state
that I have answered the above truthfully to the best of my Knowledge.
Applicant/Owner ri— ( � — cl� 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.