HomeMy WebLinkAboutRLC, GRD93-0042 - RLC Permit / Conditions - 11/3/1993 uaie neCefveU
MASON COUNTY
* DEPARTMENT OF COMMUNITY DEVELOPMENT l
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST
3�
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 earlyin the permit process whether there willbe any environmental regulations affecting
the proposed development.
Owner Phone 424�)51.&--4�667J
Site Address _ 7 n 4 — City Zip
Owner Address 6- 7gr7 Lcc�9�i/� L�-i�c= /Q City SWv�e7a��tate�t/*-Zip q,:JP'J
Tax Parcel No. (Confirm with Assessors Office) -51-Z e o / - �z/ - Oo d SC y Legal Description_
ov 7- G v _ / ;�d Ae le t S c r- / —IT.7 d ,1 L41 5 2�/
Project Description
IN
Directions to sit (Please attach map) _ �,CNOV
U' V N COUNTY
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 Yea No
❑ El X 1. Saltwater shoreline or a lake 20 acres or larger? V--b (red
El ❑ 2. Rivers, streams, or creeks with year-round flow? JU� (,/retied '
❑ ❑ 0 3. Rivers, streams or creeks with intermittent flow but are within a clearly defined channel? ku
❑ El ;K 4. Lakes or ponds less than 20 acres in size? Pilo
❑ ❑ 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
Maps for guidance.) G/,Lj?�� � Je4ut t� C 4tA-
❑ I 6. Slopes greater than 1 % (8.5 degrees)? O(See the ICoounntty Landslide and
'Erosion
" Hazard Maps for
guidance.) lk
.P� q ��}fd ���/Z c f Nczvz,(- ' �. v
❑ ❑ 7. Floodplains? (See Count
y Em Xrgecy, Sanapement Maps and County Seismic Hazard Map
for guidance.) 1J `
❑ ❑ 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.) l ,l
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
County Yea No
❑ ❑1 ❑ 1. Agricultural Open Space Taxation Program, RCW 84.33
❑ ❑ 2. Open Space Timber Taxation Program RCW 84.33, or Designated Forest or Classified Forest,
` RCW 84.34 L—[cF t,�
* Copies are available at Mason County Department of Community Development for $5.00 each.
L�
1►LJVVIIVL LP'►1ML/J %X V11111:JAL r111L!"1V
SITE PLAN
1
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 toad right-of-ways &easements. ► Location of significant natural features (water bodies, rivers).
► Locate all existing & proposed structures,dr infields, wells &driveways. ► Project description
Scale 1"= .4,5-6f ) North Arrow+
u�
fro ro5e �� '` Xx `fie
,
05e _-
I state that I have answered the above truthfully to the best of my knowledge.
Applicant/Owner Date
A'
FOR OFFICIAL USE ONLY
Adjacent property.
L
00�
: ra:::a: a::::: : ::: :::::.:..:a ... h s 4 .:.;;.:. :
;
:
:..::..:.:.....:.
�.an. �. Sh4�relirlg M�ster::::prp
...:::;::: Mnho din nd.....
P.P y
e" C esoarc I arl
. .
I ...::. ::. . .
There is a $40.00 application fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Mason
County Treasurer.
I
When completed, this form bocomos part of the permit application.
J