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HomeMy WebLinkAboutRLC94-0485 - RLC Application - 3/18/1994 Date Received:3_ ' S MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT $ RESOURCE LANDS AND CRITICAL AREAS CHECKLIST 4- 5 3 � The following 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 affected by regulations under the Mason County Interim Resource Ordinance (77-93)*. This checklist is an important opportunity foridentifying earlyin the permit process whether there willbe any environmental regulations affecting the proposed development. I Owner Phone 7 - 6V2 Site Address ) T�Q City Zi ��. z p� Owner Address ��-- �^ City State Zip Tax Parcel No. (Confirm with Assessors Office) / 2 3c -C Legal Description_ Project D scription Directions to site (Please attach map) "v � 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 ofnoi.i and resource lands are available for review at Mason County Department of Community Development, Planning u.e only Department. Do any of the following exist on this property or within 200 feet of this property? Co Yes No ❑ ❑ 1. Saltwater shoreline or a lake 20 acres or larger? 1 r El r [D 2. Rivers, streams, or creeks with year-round flow? �'�,��, El 0 3. Rivers, streams or creeks with intermittent flow but are within a clear) defined y channel? (�' ❑ Lak or ponds less than 20 acres in size? ►70� iS� �,`z_re_. ❑ ❑ 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.) ❑ © 6. Slopes greater than 15% (8.5 degrees)? (See the C unty Landslide and Erosion Hazard Maps for guidance.) p ❑ ❑ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map for guidance.) 0-0 ❑ ® 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic Hazard Map for guidance.) �ZiC 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-s�No E ❑ U 1. Agricultural Open Space Taxation Program, RCW 84.33 P/ ❑ ❑ 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 LANDS & CRITICAL AREAS SITE PLAN t 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 I state '-at I have answered the bove truthfully to the best of my knowledge. t ner i Date Vv FOR OFFICIAL USE ONLY Adjacent property. IIIVAgf<� ctl-cee--17 ........... ........ ... Us inrd Count y Rr3saur L�nd,,1�1a1� this prop is dosigrtiCc[ a 1, Lonq terror Cmmeroil forest .__ R iarelinc Master progrartR hholding Land � �.> '1) Dons not apply .:' . ;:: Mineral Resource Land , �........... ..... ..............xx.... 01 .................. ...... ........ .... ..... .............. ... . There is a $40.00 application fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Mason County Treasurer. When completed, this form becomes part of the permit application. aC o)4 vw bO -L CA 0 AIR p rR �7 p c-K J a c� f � � r'a � < <f egvEa EAS f_cv r 0