HomeMy WebLinkAboutRLC93-0542 - RLC Application - 12/23/1993 Date Received:
MASON COUNTY
DEPARTMENT OF CO
MMUNITY DEVELOPMENT
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST
T e 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 earlyin the permit process whether there will be any environmental regulations affecting
the proposed development.
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Owner Phone #(74,c. ) 275� 6(v8q
Site Address ' 9 4)A&VK Citv 'i?F-Laik Zip W)q 9 S1b
Owner Address ?a 1� ( I City x-3F LrAi(L State CUAZip_9f�S28
Tax Parcel No. (Confirm with Assessors Office) 12 37 00241y Legal Description_
72 24 of lrayr lz r 3 Sec- Sa Q w, 2�/&t Fs 046,7S, isk e'6-7 B•
Project Description_ /o ,Ah;r,0,LL 44 ;?oo-) n e l2 a -;J%GLe. %�
Directions to site (Please attach map) foam rnT S M e . -AD 24, mit
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Please p.Tvide 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
Orrlolsl 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?
Co Yes No PLO
❑ � 1. Saltwater shoreline or a lake 20 acres or larger?
❑ El 2. Rivers, streams, or creeks with year-round flow? tA-1)
,� ❑ 3. Rivers, streams or creeks with intermittent flow but are within learly defined channel?
❑ [� 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,fpr life in such conditions; such as marshes, bogs, and swamps. (See County
Maps for guidance.) 010
❑ [� 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.) '3-�)v Tt-4�
[�] ❑ [ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.)
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❑ [' 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.) � via
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
County No
-jr,Q�J D E 1. Agricultural Open Space Taxation Program, RCW 84.33
' ❑ El' 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.
RESOURCE LANDS & CRITICAL AREAS
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
I state that I have answered the above truthfully to the best of my knowledge.
Applicant/Owner Date
FOR OFFICIAL USE ONLY
Adjacent property.
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Using County Resource Land Maps, this property is designated as:
1, Long-term'. Commercial Forest 4. Shoreline Master Program
2. Inholding Land _. ....,4 G goes not apply.
3. 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 part of the permit application.
Show following on the site plan v
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements Indicate Directional by (N, S, E, W)
Name of Flanking Street
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
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