HomeMy WebLinkAboutRLC99-0064 for BLD99-0329 - RLC Application - 5/7/1999 RESOURCE LANDS & G KI I IUAL Amr-jAo %..nc%.r L_io I
Permit Number 3'�-( RLC #
Owner Parcel V30c, — ZG)
❑ 1. Saltwater/Lake 20z Acres SMP Designation
Name of Water body
❑ 2. ! Rivers, streams, or creeks 3
y� ype of Water
�I 3. `'L Lakes or ponds less than 20 acres in size? (ChecK if yes.)
❑ 4. Wetlands- Areas that are inundated or saturated by surface water that under normal
circumstances support vegetation adapted for life in such conditions as the following:
Marshes, bogs, and swamps. (Check if yes.)
❑ 5. (Lt. Slopes greater than 15% or 8.50? If yes, degree of slope °
❑ 6. Oti Floodplain? (Check if yes.) 1 � 7
❑ 7. ^, +' Seismic Hazard Area? (Check if yes.)
❑ 8. , Aquifer Recharge Area? (Check if yes.)
❑ 9. Comprehensive Plan Designation
❑ 10. Other >Au
Comments:
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Authorized Signature Date
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MASON COUNTY
RESOURCE LANDS & CRITICAL AREAS CHECKLIST
PLEASE PRINT $44.00 Fee Required
Applicant: Ow J#6A-)ey eg�k+qPre iD Parcel No. 12304
Applic nt Address: a26I 154-D .::K9�
City: St ek Zip 47t74-?r' Legal Description:
Phone:
Owner Name (if different from applicant:
Purpose of Pre-Inspection:
Use of Building:
Do any of the following exist on or within 200 feet of the property: saltwater lake
river/stream v pond wetland seasonal runoff slope
Directions to Site:
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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Sewage System Site Evaluation and
mi On-Site Y
is designed to assist an applicant for a Building Permit, g
This checklist9 PP
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:
Return application to: Department of Community Devolopment,nanning Division
411 N. 5th/P.O. 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:
Departmental Review
(For Office Use Only)
Planning Department Findings: