HomeMy WebLinkAboutRLC94-00560 Cancelled - RLC Application - 4/15/1994 •7 C'
O Date Received: L
MASON COUNTY
PP 0D DEPARTMENT OF COMMUNITY DEVELOPMENT 171
LOR
SAND CRITICAL AREAS CHECKLIST
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The following check tis� Pn?da1iJ9* 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
Segregation �a � Shoreline Permit in determining whether their property is affected by
regulations un rim Resource 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.
Owner. -fOh,i1 Iq Phone #(.2,09 ) .7,7,5 -//90
Site Address 1VF /.Zc2 Tin, ,(-
City deArn I r Zip ,:oZ?3
Owner Address MF AR0 ir✓'r7Pr/inv. 01- City ge ir State)t Zip 1727J�ZY
Tax Parcel No. (Confirm with Assessors Office) 3_- elCO/30 Legal Description_
Project Description 5j L ,�-
Directions to site (Please attach map) 0• -3 ei/r Ale rJA o.(' tAe. 1&1t,_r3 c_ c•f on C7n Ni��c
GrV4 t1/� Bph�if�� f�i?!��.v�y o.� fife t�•e'sf si��� �Y" O/�� l3 /�'cw1r /•1i�tA!Lv yc-
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Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc.
o�i d
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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 Only Department.
Do any of the following exist on this property or within 200 feet of this property?
County yea No
❑ ❑ ] 1. Saltwater shoreline or a lake 20 acres or larger?
❑ ® ❑ 2. Rivers, streams, or creeks with year-round flow? %'2
❑ ❑ 2 3. Rivers, streams or creeks with intermittent flow but are within a clearly defined channel?
❑ 2 ❑ 4. Lakes or ponds less than 20 acres in size?
❑ ❑ J9 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.)
❑ ❑ 2 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.)
❑ ❑ 2] 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.)
❑ ❑ ® 8. Seismic Hazard Areas? (See County Federal Emergency 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 yes No
❑ ❑ .K 1. Agricultural Open Space Taxation Program, RCW 84.33
❑ ❑ 14 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 S5.00 each.
RESOURCE LANDS & CRITICAL AREAS
t 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.
► 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
state that I have answered the above truthfully to the best of my knowledge.
Applicant/Owner Date
FOR OFFICIAL USE ONLY
Adjacent property.
Using County RQscurce Land Maps, this property is designated as:
1. Long-teal: CornmorGial Forest _ �. Shoreline Master program
.., . iriholding Land ..., 5, Does not apply,
3. Mineral Resource Lan(#
Date
There is a $40.00 application fee for the Resource Land & Critical Areas Checklis
t. Make checks payable to the Mason
County Treasurer.
When completed, this form becomes part of the permit application.
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