HomeMy WebLinkAboutRLC93-00140 - RLC Application - 10/28/1993 COpy Date Received:
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Ins eel-Wt''-cam, DEPARTMENT OF COMMUNITY DEVELOPMENT
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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, 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 early in the permit process whether
there will be any environmental regulations affecting the proposed development
Owner b �� one # 6
Site Address �-�o ��9 c� City Zip
Owner Address /w/3vX 7,G 7 City Stater/ Zip dF
Tax Parcel No. �a'33 - ,S�/ - 042d -,-e Legal D cription
Directions to site (Please attach map) S_ee
Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc.
Answer the followingto the best of our knowledge. County-wide maps showing general locations of critical areas
Y g Y p 9
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?
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1. Saltwater shoreline or a lake 20 acres or larger?
❑ [ 2. Rivers, streams, or creeks with year-round flow?
❑ 3. Rivers, streams or creeks with intermittent flow but are wit in a clearly defined channel?
❑ 4. Lakes or ponds less than 20 acres in size?
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Id ❑ 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstances
support vegetation adapted for life in such nditions; 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.) Y140
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El7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.)
❑ 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.) ( b
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
Coy 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
3 �
Copies are available at Mason County Department of Community Development for $5.00 each.
or
SITE PLAN
4
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.
Scale 1"= North Arrow
I state that I have answere e above truthfully to the best of my knowledge.
Applicant/Owner �v 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.