HomeMy WebLinkAboutRLC94-0248 - RLC Application - 2/14/1994 Date Received: IZ 14 T
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
0 a48 RESOURCE LANDS AND CRITICAL AREAS CHECKLIST Z' a
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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 (77-93J*. This checklist is an importai
opportunity for identifying early in the permit process whether there will be any environmental regulations affectir
the proposed development.
Owner (Bhpne #( y) ToZ7-7�/
Site Address Z �" City Zip
Owner Address City t ew Zip Ud -'
Tax Parcel No. (Confirm with Asses ors Office) )Cyo Legal Description_
_ ZA<\ � f
Project Description
Directions to site (Please attach map) t U_
I r,=.
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 area,
Official and resource lands are available for review at Mason County Department of Community Development, Planning
U..oniy 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?L ,n ^�
�] ❑ El" 9 2. Rivers, streams, or creeks with year-round flow? U
E� ❑ 2' 3. Rivers, streams or creeks with intermittent flow but are within a cfe�arly defined channel?
❑ 0' 4. Lakes or ponds less than 20 acres in size?
❑ ❑ B' 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstance;
support vegetation adapted for life in such conditions; such as marshes, bogs, and swamps. (See Count
Maps for guidance.) f1'1
❑ ® 6. Slopes greater than
15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps foi
guidance.) 3
❑ [� 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Mar
for guidance.) /ilk)
❑ [ 8. Seismic Hazard Areas? (See 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 $5.00 each.
RESOURCE LANDS & CRITICAL AREAS
SITE PLAN
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
P. 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. P. Project description
Scale 1"= North Arrow
I state that/I have answered the above truthfully to the best of my knowledge. �/ 9
/ �i' l L (J Applicant/Owner 7 / Dat(
FOR OFFICIAL USE ONLY
Adjacent propV-LA
Using County Resource Land Maps, this property is'designAted as,
�, l ong40w.. CQ 0mordal Forest Shore. 11 M st r rogr�
W Mnhold) g I~�nd f?p y
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I 3. MinerahResource Land........:::>:;<:.::::<.':. ;;:..: »:::<>:<::;::<::;:.::..:..::::::::::.>:«:::>::>.
:.w.:• . r... '..
fete ,:....:.; .... :: :. . :. CGD.
There is a $40.00 application fee for the Resource land & Critical Areas Checklist. Make checks payable to the Masoi
County Treasurer.
When completed, this form becomes part of the permit application.