HomeMy WebLinkAboutRLC2001-00005 - RLC Application - 1/23/2001 i
t MASON COUNTY A/1 6(/
RESOURCE LANDS & CRITICAL AREAS CHECKLIST
PLEASE PRINT $70.00 Fee Required
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Applicant: — - Parcel No. 1 320
Applicant Address: 4 o y -� a I
City: � _StaZLzip_ a y Legal Description:
Phone: (3(v) '2 -2 -S 3 31
Owner Name (if different from applicant:
Purpose of Pre-Inspection: Id ' T q
Use of Building:
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: U/e5( 61°/ fa - Z 6 i A' L r" T ea,, '" -i'/�',v�°
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):
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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: S Date: G
Return application to: Department of Community Development,Planning Division
411 N. 5th/P.0. Box 578
Shelton, WA 98584
(380)427-9870 ,See 2 o i W 23N
Please make checks or money orders payable to Mason County Treasurer
When completed, this form becomes part of the permit application.
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12'7 -2- 01 Sv
Please illustrate below the proposed building site in relation to critical area & property lines:
Departmental Review
(For Office Use Only)
Planning Department Findings:
I� I 454741*-
i ��/ � BIZ I•• :�000' I Short Plat /ei_,1 _
454742 1pprovd 7*3
Z � �o� Tanning Directo
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YJARNING: Mason County has no responsibility to
�1 build, improve, maintain, or otherrise service
the private roads contained within or providinC
by service to the property described in the short
h� plat,
V/C//V ITY MAP
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NOTE: .TOHN R.HU501V AND 1-1ARGAk: ' � o•I � `
HUSON ARE THE OWib'E/CS OF
THE LAND DOOMD/NG THE
THE LVES rNog-rH AAD EAST N j
S/DE5 OF THIS 5HOX7 /rAr..
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12 5.00- Ul 3 5 88_Y 3 07 E 704.20
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SUBJECT
a ^ PROPERTY
OWNER' ••-1V 88' '+O'OT" W
THOMAS W. DAV1.5 po
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OIVN ER:
PiIUL A. 5A✓A6.5 Z
_,4 Po,erION OF S.W.he, 5.E.�Y, 20-23N:I k/., W.M.
Zo, 132747• co Z
J'O,A-1/V R. HUSON � 2� ''; 588•vob7" 2Q/ 2
•••2G55.33`' L
N.E. 80/ O:-O BEe FAIR HWY.
6E4.FA19e1 KIA. 9852.3
(e--75- 2/52)
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