HomeMy WebLinkAboutRLC94-0024 - RLC Permit / Conditions - 1/5/1994 • Date Received: i S 114
• � � MASON COUNTY If
DEPARTMENT OF COMMUNITY DEVELOPMENT 3'--1 2 Z. .
RESOURCE LANDS AND CRITICAL AREAS CIQ n
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The following checklist is designed to assist an applicant for a Building Permit, On-Site Sewage S D
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Evaluation and Disposal Permit, Access Permit, Land Modification Permit, BoundAV D4 . stments, Land
Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affected by
regulations under the Mason County Interim Resource Ordinance t77-9 MAU ' portant
Opp ortunit y for identifying ear/v in the permit process whether there will be a" =fecting
the proposed development.
Owner t�. (-f ( �'). Phone T(5o� )
Site Address f a��l IU• Sl�trr? Z� City cJA . Zip
Owner Address Si� 2 City State Zip
Tax Parcel No. (Confirm with Assessors Office), - ez)( - t20030 _Legal Description_
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Project Description_. ADD a
Directions to site (Please attach map) S iS� ?O 1 A4 — AJ L5L'ore H nA Coy-at
Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc.
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Answer the following to the best of your knowledge. County-wide reaps showing general locations of critical areas
onioi&I and resource lands are available for review at Mason County Department of Community Development, Planning
Use ONY Department.
Do any of the following exist on this property or within 200 feet of this property?
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❑ 1. Saltwater shoreline or a lake 20 acres or larger?
❑ 2. Rivers, streams, or creeks with year-round flow? t
❑ 3. Rivers, streams or creeks with intermittent flow but are within a cleaxly defined channel?
❑ [ 4. Lakes or ponds less than 20 acres in size? 4
Q ❑ ;7 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.) VW
❑ Jar 6. Slopes greater than 15% 18.5 degrees)? (See the County Landslide Erosion Hazard Maps for
guidance.) ".5p1� r„_. 'j �_\e-
(� ❑ ?,t 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazakl Map
/ for guidance.) Vw
❑ jo; 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.) V—V
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
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(]1_ 1. Agricultural Open Space Taxation Program, RCW 84.33
t--r ❑ 2. Open Space Timber Taxation Program, RCW 84.33, or Designated Forest or Classified Forest.
/ RCW 84.34
• Copies are available at Mason County Department of Community Development for $5.00 each.
,. 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 fwater bodies, rivers).
► Locate all existing & proposed structures,dralnNelds, wells & driveways. ► Project description
Scale 1"_ 40North Arrow
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I state that I have answered the above truthfully to the best of my knowledge.
Applicant/Owner Date
FOR OFFICIAL USE ONLY
Adjacent property. ff
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USing'County Resource land MapSAJIlls property Is dosipated as:
1: Long-tern, Comr»atcial Forest 41 Shoroline Mastor. Program
2. Irtholdincg Land 5, Does riot apply.
3. Mineral Resource Land r
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There is a $40.00 application tea 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.
, '`SHORT PLAT OF GOVERNMENT LOT (6) AND A PORTION OF GOVERNMENT LOT
(5) , SECTION (35) , TOWNSHIP (22) - NORTH, RANGE (3) WEST, W.M.
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S SUQT�G��, SELLER: George R. Brown
1810 Cherry Street
Port Townsend,
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