HomeMy WebLinkAboutRLC Application - 5/17/2000 MASON COUNTY
RESOURCE LANDS & CRITICAL AR AS CHECKLIST
PLEASE PRINT ( ct ( tob 1
$70.00 ee Required
Applicant: er Parcel No. _39P35 -SD - DDe7'l
Applicant Address: C
City: 4>rI=.me-rh)rn Sth?,5 Zip i Legal Description: bra
Phone: . L7?/A6 )691?29P9 mr 7T-S7a1 AVOJ C r)a I TRS 79 4 d- 7. •L..
Owner Name (if different from applicant:
_� c3.-. alQo ca•��a�,f/'lic/�a�/ Perry C�J
Purpose of Pre-Inspection: a o�
U g: -1fce - - DOD an ac ,
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: 0 earil cc�S e_ a» e a;Jba
_ t!-_S&rc f7?�_ J�ODTe,, a� L -- - l ow,n_�� ���� Cl,%�• — ---
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 ..
�/eDse' 're ��er �0 J �Q zl_1�aGAed1 c.-renswin8 c�J�icl�
l,�'CludeS aJ Y�o,f&r17 Ownc4r na,.��-� �aYc el s Dr-)J re1a Led
C0p-7ele7ed &d s,8ne j off �-7 30cile 4J9/dcr0J4 0 -a060
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 early 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 valid only until development changes occur in the vicinity which affects the
lot evaluated in this inspection.
Applicant Signature Date: �'S�=J 7- ;9000
Return application to: Department of Community Development,Planning Division
411 N. 5th/P.0. Box 578
Shelton, WA 98584
(380) 427-9870
Please make checks or money orders payable to Mason County Treasurer
When completed, this form becomes part of the permit application.
Please illustrate below the proposed building site in relation to critical area & property lines:
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Departmental Review
(For Office Use Only)
Planning Department Findings:
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