HomeMy WebLinkAboutRLC94-0407 - RLC Inspections - 3/4/1994 Date Received: ` " '_(
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT nz=
• O RESOURCE LANDS AND CRITICAL AREAS CHECKLISTej
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 early in the permit process whether there will be any environmental regulations affecting
the proposed development.
Owner �; �r Phone #06 L/J?- /_!S 73
Site Address_ _,,� f r'y y City e �4-"\ Zip , Y-t/
Owner Address f, Yl City Statej,&LZip
Tax Parcel No. (Confirm with Assessors Office) L-1.1Gy - "7 `70 10 t Legal Description_
,project Description �U i
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Directions to site (Please attach map)_ T.,\s le, I
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Please provide or attach a vicinity map which includes cross streets, ma r 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 omy Department.
Do any of a following exist on this property or within 200 feet of this property?
C�c'" Yes No '- ^
LJ ❑ 1. Saltwater shoreline or a lake 20 acres or larger?
❑ � 2....Rivers, streams, or creeks with year-round flow?
LJ ❑ ��3. .Rivers, streams or creeks with intermittent flow but are wi a clear)
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y defined channel?
1 ❑ kas or ponds less than 20 acres in size? tq
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E ❑ 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstances
support vegetation adapted for life in such conditions; such as marshes, bogs, and swamps. (See County
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Maps for guidance.) ",°,,
P ❑ 6. Slopes greater than 15% (8.5 degrees)? (See the County Landsiide and Erosion Hazard daps for
guidance.)
1
a Show following'on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells z
Proposed Improvements Easements Indicate Directional by (N, S, E, W)
Name of Flanking Street in relation to plot plan
Name of Fronting Street
APPLICAN r TO DRAW SITE PLAN BELOW
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW 1
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ttr---')uuttUt LAIVUS & GKI I IGAL 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,drainfieids, wells &driveways. ► Project description
Scale 1"= North Arrow
state that I v nswered the above truthfully to the be� knowledge.
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Applicant/Owner — /O�/I `lG Date
FOR OFFICIAL USE ONLY
Adjacent property.
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