HomeMy WebLinkAboutRLC94-1083 - RLC Application - 5/16/1994 Date Received:
RL
1400 MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE LANDS AND CRITICAL AREAS CHE KLIST "SG [
The following checklist is designed to assist an applicant for a Building Permit, On-Site Sewage System Si
Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Line Adjustments, Lar
Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affected L
regulations under the Mason County Interim Resource Ordinance (77-93)*, This checklist is an importar
opportunity foridentifying e_ arlvin the permit process whether there willbe any environmental regulations affectir,
the proposed development.
Owner e0
� �� �'�'`� Phone #z-� )2"15—S33 7
Site Address E 'l 4a�v 3ov.t. Cv� �-t- 6earas � ity -6c��+�r Zip \Va
Owner Address P.O . (3onc '7a$ City StateWaZiposts'L%
Tax Parcel No. (Confirm with Assessors Office)_\Z-"a - _- 0443q Legal Description
3y —
Project Description �1 l..+y 'Qes•.��.e•�►
Directions to site (Please attach map) k4,3%Yf AN S\noccc 'RI 'iZ���-� a Sa�Z \A t
�.-c-� o�. �rc.�.o r �'�''�v e , ` �a�'� �-o A0.•+y 30 4.c s C:o y y-"C-
Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc.
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SAW
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Answer the following to the best of yo k wledge. County,-wide maps showing general locations of critical area
ornei,i and resource lands are available for rev a at Mason County Department of Community'Development, Planning
uto oniy Department.
Do any of the following exist on this property or within 200 feet of this property?
Cou Yes No
1. Saltwater shoreline or a lake 20 acres or larger?
❑ 2. Rivers, streams, or creeks with year-round flow? 3 4&re4i4-,.,
❑ ❑ 3. Rivers, streams or creeks with intermittent flow but are within a early defined channel?
❑ ;3::�' 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.) P1�19
❑ 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.)
(� ❑ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
/ for guidance.)
E� ❑ 8. Seismic Hazard Areas? (S,@e County Federal Emergency Management Maps and County Seismic
Hazard Ma for guidance. ,& /11
P 9 ) ('`ICJ
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
Courdy Yes N
❑ 1. Agricultural Open Space Taxation Program, RCW 84.33
/JZ ❑ 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.
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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
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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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.
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