HomeMy WebLinkAboutRLC94-1145 - RLC Application - 5/23/1994 Date Received:
MASON COUNTY
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 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 earlvin the permit process whether there willbe any environmental regulations affecting
the proposed development.
Owner_ cL&'%iA 1�V�gDY� y Phone IIL2V 7;7 —q63el
Site Address OP 11300 City&42;1 , Sh Zip�S
Owner Address<Z, (kee_J)L Lepj� LS City_. Stat(� Zip;
Tax Parcel No. (Confirm with Assessors Office)_Z1336)E -� _- ,9M90 Legal Description_
Project Description
Directions to site (Plea a attach map)
R1 -- -
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
omcia and resource lands are available for review at Mason County Department of Community Development, Planning
u..0N1, Department.
Do any of the following exist on this property or within 200 feet of this property,)
C_--11r Yc$ No
❑' d 1. Saltwater shoreline or a lake 20 acres or larger? A
a/ ❑ 2. Rivers, streams, or creeks with year-round flow?
❑ , 3. Rivers, streams or creeks with intermittent flow but are within a clearly defined
/fcha�nel?
[}' ❑ �j 4. Lakes or ponds less than 20 acres in size?
/[J' ❑ 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circurnstances
support vegetation adapted for life i/nI such conditions; such as marshes, bopsaan wamps. (See County
Maps for guidance.)
�J ❑ G. Slopes greater than 1 5% (8 � �
/ { fl 18.E degrees)? (See the County Landslide and Erosion Hazard ps
guidance.)
❑ „� 7. Floodplainsl (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.) 0/n
❑ .� 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.) //L/O
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following proorams:
Co 1 ❑ r 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
• Coplos are avalloblo at Mason County Departmont of Community Dovelopmont for $5.00 oech.
i I
RESOURCE LANDS & CRITICAL AREAS
SITE PLAN
?LEASE 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,wldth of all road right-of-ways&easements. ► Location of significant natural features(water bodies, rivers).
Locate all exis�tiinngg� & proposed structures,drainflelds, wells & driveways. a, Nolect dascriptlon
Scale 1 �� North Arrow V
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TJ
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state that I have answered the above truthfully to the best of my knowledge.
Applicant/Own r L&DDate
FOR OFFICIAL USE ONLY
>djacent property.
AV 6111�
Using' County SOSOQrfrfo I,�nd Maps. this'property i.s designatad'as.
1, hang farm Commerol Fprast ;h, Shorolrna Master'Program
. Inhaldln Land; 5, taaea not apply:
3 Mineral ReBourca an
D D
here is a $40.00 application lee for the Resource Land $ Critical Areas Checklist. Make checks payable to the Mason
ounify Treasurer.
hen completed, this form becomes pert of the permit application.