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RLC93-0484 - RLC Inspections - 12/13/1993
+ Date Received: MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT -� RESOURCE 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 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 identifying early-in the permit process whether there will bean y environmental regulations affecting the proposed development. Owner KC17"I F—a Col- #(2_cc Site Address 5C'F _T YVT_ rk �,�cr r:,�ot,rc� City Zip 1765_5 ( Owner Address. TO R051 `72, City,5"He4; ^ Statet4/A.Zip `V5-;V Tax Parcel No. (Confirm with Assessors Office) q.200 - 7 g-? _ Legal Description S?J7 ,7340 i *Z 3 - Project Description ST--m Directions to site (Please attach map) nA.) '77L4/i_j 5t�67 "Ap g T'gch-7} 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 uae only Department. Do any of the following exist on this property or within 200 feet of this property? Co, t Yea No ❑ ® 1. Saltwater shoreline or a lake 20 acres or larger? ❑ © 2. Rivers, streams, or creeks with year-round flow? ❑ � 3. Rivers, streams or creeks with intermittent flow but are within a clearly defined channel? E; ❑ ® 4. Lakes or ponds less than 20 acres in size? L' El1111i 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstances support vegetation adapted for life in such condition stych as marshes, bogs, and swamps. (See County Maps for guidance.) q ❑ 0 6. Slopes greater than 15%/ (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for / guidance.) ❑ ❑ X 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map for guidance.) l-t ❑ 0/ 8. Seismic Hazard Areas? See Federal � County de al Emergency Management Maps and County Seismic Hazard Map for guidance.) U42j You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any of the following programs: Co Yea No ❑ ® 1. Agricultural Open Space Taxation Program, RCW 84.33 ❑ 2. Open Space Timber Taxation Program, RCW 84.33, or Design ted Forest or Cl RCW 84.34 srfred Forest, /— ,pies are available at Mason County Department of Community Devel RESOURCE LANDS & CRITICAL 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,drainfields, wells &driveways. ► Project description i Scale 1"_ North Arrow Kl C 7L .3 ;r I state that I have answered the above truthfully to the best of my knowledge. Applicant/Owner �2- Ps 13 Date FOR OFFICIAL USE ONLY Adjacent property. 0 co u =F OR) ,r V W0 � x m Z'� v, 01 o co i' VV arYtl.ft/Ia � hip.; t ' ;:.;:.::.;:.;::.:::..:.::.................................... .......::::. .................... ::::.:................:::.::::.............:...::::::::...........::::::::......................:..::....... ...............::::::........��..}..........:.:::::..................:...::.................:.:::::::...............::.:::::.............. .:.... ::::a:; �o-:isi : <`..... >>F >!<< There is a $40.00 application fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Mason County Treasurer. ompleted, this form becomes part of the permit application. -S 00'44.3J' W N 0()•44•3.1'r 1d19.43 I -619W -J29.86--- -J29.85---4 -J29.80---4 t DD �:10 �I I w`^J N-�-•4'�N y p 1 q N �� N � �� 1 ! 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