HomeMy WebLinkAboutRLC94-1041 - RLC Inspections - 5/10/1994 MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
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RESOURCE LANDS AND CRITICAL AREAS CHECKLIST
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 for identifying early in the permit process whether there•will be any environmental regulations affecting
the proposed development.
Owner Phone lil 206 ►275' - 377Z.
Site Address i 6 eitfA ' a✓E— City Bt'4j'e Zip S';2
Owner Address sG.KP r City State Zip
'Fax Parcel No. (Confirm with Assessors Office) / ,2 3.2/ - 20Legal Description
Gott- A. 0� S� � 5f 7� a,- L.ofZD - —
Project Description 0//4 Zisl- ,4or Fulyee 4aA*-,2-
Directions to site (Please attach map) 90 YO 0lj) /�ii- �, w�,, �a�y�.r Nff 04A
y rn 04- o ,n Rc1 -1-n J t• h t I I t�
Please ro ide or attach a vi inity map which includes cro s streets, m ' r�roads, creeks, etc.
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Answer the following to the best of your knowledge. County-wide maps showing general locations of critical areas
011101d and resource lands are available for review at Mason County Department of Community Development, Planning
We orgy Department.
Do any of the following exist on this property or within 200 feet of this property?
Cojinty Ya NoLd
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L 0 1. Saltwater shoreline or a lake 20 acres or larger? V1�i�U
[`J ❑ 1 f� 2. Rivers, streams, or creeks with year-round flow?
❑ ( 3. Rivers, streams or creeks with intermittent flow but ar within a clear) defined,• ,� Y channel?
❑ ] 4. Lakes or ponds less than 20 acres in size?
Cl ) 5. Wetlands: Areas that are inundated or saturated by water surface t that under normal circumstances
support vegetation adapted Aor life in such conditions; such as marshes, bogs, and swamps. (See County
Maps for guidance.) nAl
❑ 6. Slopes greater than 15% (8.5 degrees)? (See the County Land slid and Erosion Hazard Ma s fo
guidance.) �i ��
❑ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.) q
❑ ❑ 8. Seismic Hazard Areas? (,� 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:
C unt Yes No-
AA 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
1
• Copies are available at Mason County Department of Community Development for $5.00 each.
1, 51 I L I-LNIV
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
► Location &dimensions of existing & proposed property boundaries. ► Approximate slope of lend (grade &direction), topography.
► Identify legal access Including,width of all road right-of-ways &easements. P. Location of significant natural features(water bo(Iies, rivers).
► Locate all existing & proposed a res, Inflalds, wells &driveways. ► Project description
Scale 1"= /off
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I state that I have answered the above truthfully to the best of my knowledge.
Applicant/Owner — Date
FOR OFFICIAL USE ONLY
Adjacent property.
Using County PO$OUroo band M40, thly prOj)orty I$ dasjdnat(td a�
, 1, l Qttd�tdrrtZ ptf1Ytlpr�:I ll breSt _ Shorollno Mas�tor pto gram
2. 111 olding and 6 C�p,~a nat apply,.,,.
Mineral Resource Land • .
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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 port of the permit application.