HomeMy WebLinkAboutRLC94-1163 - RLC Application - 5/25/1996 Date Received; . 'r?� eq
MASON COUNTY
1 o DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST
The following checklist is designed to assist an applicant for a Building Permit, On-Site Sewage System Sitc
Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Line Adjustments, Lanc
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 ear/yin the permit process whether there willbe any environmentalregulations affecting
the proposed development.
Owner v G V Phone # f� a7s �lyb
Site Address 0 city__ 2 WA ZIPTZSZA _
Owner Address Q U ,,,i,,,,j� -.T-- �� City State �. Zip q���,g
Tax Parcel No. (Confirm with Assessors Office) 0 - __ a A -O Legal Description
Project Description r.
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Directions to site (Please attach map)
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Please provide or attach a vicinity map which includes cross streets, major 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
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 Yes No
❑ ` 1. Saltwater shoreline or a lake 20 acres or larger?
❑ ❑ 'R 2. Rivers, streams, or creeks with year-round flow?
❑ 3. Rivers streams or� creeks with Intermittent flow but are yy'thin a clearly defined channel?
❑ (R 4. Lakes or ponds less than 20 acres in size?
❑ 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 County Landslide and Erosion Hazard Maps for
guidance.) C-20) �'�����!�,�ti�(,PI,,
❑ 7. Floodplains? (Se_e County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.) M
❑ 8. Seismic Hazard Areas? (S e 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
❑ ❑ 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
Copies are available at Mason County Department of Community Development for t5.00 each.
r�L000n%-oV_ LL/-%avLs%), CX Bill I IIrHL HlAr-A0
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 exlating &proposed structures,drainfields, wells &driveways. ► Project description
Scale 1"=
North Arrow
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state th I e ans ere the/� e ,tr'uthfully to the best of my knowledge.
Applicant/Owner -Date
FOR OFFICIAL USE ONLY
Adjacent property.
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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 part of the permit application.
r Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography ,
Septic Systems Wells
Proposed Improvements Easements '
Indicate Directional b N S
Name of Flanking Street in relation t y plot
E, W� )
Name of FrontingStreet p- p
APPLICANT TO DRAW SITE PLAN BELOW
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW