HomeMy WebLinkAboutRLC94-1015 - RLC Inspections - 5/5/1994 -,OwlF r L
Date Received;__
MASON COUNTY �- S 4
i 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 S,
Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Line Adjustments, La,
Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affected
regulations under the Mason County interim Resource Ordinance (77-93)*. This checklist is an importa
opportunity for Identifying early_in the permit process whether there willbe any environmental regulations affecti the proposed development.
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Owner_ f" '/R o,J A. 4- CAkOLyilAl KA'lf� St u e tii A Phone #( Z�) g{yi -73o I
Site Address I-c T q i 1"Sek•r, pES City U�J o1J Zip S'qZ
Owner Address S oolf CAfvrA - SPA 19J61 'a2 CityB1,017126c' AStatewli- Zip giro
Tax Parcel No. (Confirm with Assessors Office) 3 2 2.3 S'7S-o0 0
---�_--9a Legal Description_
T2crcT- 9 of S�2V`�is VOL- t Phc� � - 2'3
Project Description k N j},�,4 G �/ w .� �i c S y71
Directions to site (Please attach map) R i o 4 -� , fir- ar UN 10N
�2 R T'irt8a`RTraES '2�2fyc: �o Ton c r4t�t( I M,LLr)
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Please prov de 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 maps showing general locations of critical area
Meld and resource lands are available for review at Mason County Department of Community Development, Planning
Use orgy Department.
Do any of the following exist on this property or within 200 feet of this property?
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❑ ❑ 1. Saltwator 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?
❑ ❑ �. 4. Lakes or ponds less than 20 acres in size? r
❑ ❑ 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.) a
❑ ❑ 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.) 0T— N pT- chi C-
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❑ ❑ 7. Floodplains? (SeA County Fe(leral Emergency Managemen
for guidance.) Maps and County Seismic Hazard Map
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❑ ❑ 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map 'nr guidance.)
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You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
county
❑ 0 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
* Copies are avaflable at Mason Cnimfy Department of Communitv Dnvnlnmm�nt fnr sti nn nn�h
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.
P. 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
Scale 1"= North Arrow
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state that I have answered the above truthfully to the best of my knowledge.
Applicant/Owner s C y Date
FOR OFFICIAL USE ONLY
Adjacent property. y0
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Reswl l O Lan(] Maps, this proport is ci(ysicjnatod as,
Lorly tern. Comrft4roiaE'}"crest I.�..W._.r4. Shc Master pY4Jr�frtt
>;.::•. ;<:«><:><:<:»:<....... Inholciing Land 5. Does trotapply:
8. Minf,r,J Resource Land'
ate
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There is a $40.00 application fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Mason
County Treasurer.
When completed, this form becomes px, of the permit application.