HomeMy WebLinkAboutRLC94-0638 - RLC Application - 3/31/1994 -315
MASON COUNTY Date Received:
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DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST
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The foll ng 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 (77-931*. 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 j1�ssE�& 4 qol &,gam/ ✓ Phone #( 7
Site Address 47o 4/1 1--, SG/fa ty 9&__4 12 Zip 99,. _Z-B
Owner Address IiI 44D �sf/9.ii�A ;?o �Be�►'/o-2S0 City State V,4 Zip 99 s-ZA
Tax Parcel No. 14:3U - �— DD Legal Description
Directions to site (Please attach map) ?v S,4.t/D /�L
114 C S X/ z�_ 1/0 . Lai /S Dot/ ,IV, D r— GA 12 SoA/ ,moo r9.ti 2
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 areas
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?
Cou Yes No
❑� 1. Saltwater shoreline or a lake 20 acres or larger? `
❑ ED"' 2. Rivers, streams, or creeks with year-round flow?
E� ❑ [2/' 3. Rivers, streams or creeks with intermittent flow but are in a clearly defined channel?
El []/ 4. Lakes or ponds less than 20 acres in size? �� n1 '
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❑ []' 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.) M
E/ G 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.) _ I—
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1 S� � z S
❑ EJ' 7. Floodplains? (See County Federal Emergency Mdnagement Maps and County Seismic Hazard Map
for guidance.) e—IG
❑ [ 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:
CW.mey Yee No
❑ ED' 1. Agricultural Open Space Taxation Program, RCW 84.33
(� ❑ E Y 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.
r RESOURCE LANDS & CRITICAL AREAS
SITE PLAN
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PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
► Location&dimensions of existing &proposed property boundaries. P. 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
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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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•e is a $40.00 application fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Mason
t'ty Treasurer.
.ompleted, this form becomes part of the permit application.