HomeMy WebLinkAboutRLC - RLC Application - 8/14/1998 MASON COUNTY
RESOURCE LANDS & CRITICAL AREAS CHECKLIST
PLEASE PRINT $44.00 Fee Required
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Applicant: Q � i>� Parcel No. -
Applicant Address: (-?Ito ifwZ l�
City: L c l L O-Al st- , Zip Legal Description: _Z"-at Q.C.,54
Phone: .1 �4L =:k 4 <, qq.6F 3 fv�ST
Owner Name (if different from applicant: 7R Z UG 4071-3 T.L.
,a0"Ns9A L06cCE S4)!40 J.£,% AEG. 34. TaAr L"
Purpose of Pre-Inspection:
Use of Building: D ASLG
Do any of the following exist on or within 200 feet of the property: saltwater lake
river/stream pond wetland seasonal runoff slope
Directions to Site: /� ��- r �� C -�� � �'✓� �C"L t �`—
Please illustrate in the box below the proposed building site in relation to property lines,
significant natural features, slope grade and direction and topography (or include on separate
sheet):
North Arrow
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This 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 affect by regulations under the Mason
County Interim Ordinance (77-93). This checklist is an important opportunity for identifying eaft in the permit process
whether there will be any environmental regulations affecting the proposed development.
If the information is incomplete, then Mason County must disclaim any errors resulting from deficiencies in the original
application. Pre-inspection reports remain v lid only un ' development changes occur in the vicinity which affects the
lot evaluated in this inspection.
Applicant Signature: / Date:
Return application to: Department of Community Development,Planning Division
411 N. 5th/P.0. Box 578
Shelton, WA 98584
(360) 427-9670/1-800-562-5628
Please make checks or money orders payable to Mason County Treasurer
• When completed, this form becomes pert of the permit application.
Please illustrate below the proposed building site in relation to critical area & property lines:
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Departmental Review w
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Planning Department Findings:
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