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HomeMy WebLinkAboutRLC94-1036 - RLC Application - 5/10/1994 Date Received: MASON COUNTY As Rtqqe DEPARTMENT OF COMMUNITY DEVELOPMEN It V NO RESOURCE LANDS AND CRITICAL AREAS CHECKLIST [A,-) 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, Bounary Line Adjust , Lai Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affetcted regulations under the Mason County Interim Resource Ordinance (77-93)*. This checklist is an importa. opportunity foridentifying earlvin the permit process whether there will be any environmental regulations affectil the proposed development. Owner ,. i s CJ��� Phone #�©6 Site Addresses 9&& Owner Address City / 1V Zip s ' �� City 2 / State Zip Tax Parcel No. (Confirms with Assessors Office), — 7 ��- d��� Legal Description Project Description Directions to site (Please attach map) S'• �_r /0� 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 orjy Department. Do any of the following exist on this property or within 200 feet of this property? County No ❑ ❑ 1. Saltwater shoreline or a lake 20 acres or larger? ❑ ❑ L1J 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? ❑ ❑ 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.) ❑ ❑ 7. Floodplains? (See County Federal Emergenc Mana for guidance.) Y Bement Maps and County Seismic Hazard Map ❑ ❑ 8. Seismic Hazard Areas? (See County Federal Eme rgency Management Maps and County Seismic Hazard Map for guidance.) You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any of the following programs: County Ye_ No ❑ ❑ ❑ 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 available at Mason County Department of Community Development for $5.00 each. RESOURCE LAND' & 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. P. Project description Scale 1"= North Arrow 1 6Pms­y) IT 06 I state that I answered the ayavet thfully to the best of my knowledge. Applicant/Owner Date FOR OFFICIAL USE ONLY Adjacent property. �n rlrtti q 3 S( l t�ic.le �/l,�Q IV&(Z*f " '/-?) 36 to -I S��► 03 �� 1 I /��J •r A)T v "" �:ri }, �.. Y},6•a.•:.vx::::.:vY'v:a}::.::�:::.:, ..k':?tip J.�a.,.1N{.;Art �dY }}}i}iiiiy}}:�}i}:Cii::.�:.:.�::::::::::}}:: ::>}:: ..,}_:{,{:;:Y. 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Make checks payable to the Mason County Treasurer. When completed, this form becomes part of the permit application. I � i