HomeMy WebLinkAboutRLC93-0469 - RLC Application - 12/7/1993 MASON COUNTY Date Received:
EPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST S
The /lowing 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 for identifying early in the permit process whether there will be any environmental regulations affecting
the proposed development.
Owner C K� C_JW A.) Phone # � ) >J--
Site Address L—_ 7 D i � C'� �1p 4 ,�� City t��=L�,�9 I � Zip s—z
Owner Address, �s3 6 i /n Q y /c .fzz N t r� City (= r!Z Stated/ ip_
Tax Parc No. (Confirm with Assessors Office)_ / 3 3 O -
�� �-- �L`f Q d Legal Description_
Project Description r
tt E C
Directions to site (Please attach map)
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
omei.i 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?
Coffin Yes No
/^
L'1 ❑ LY 1. Saltwater shoreline or a lake 20 acres or larger?
❑ [D 2. Rivers, streams, or creeks with year-round flow? vl/ '?
❑ [2 3. Rivers, streams or creeks with intermittent flow but are within a clearly defined channel?
ff/ G
❑ � 4. Lakes or ponds Less than 20 acres in size?El EA/
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.) Lltp
❑ [� 6. Slopes greater than 15% (8.5 degrees)? (See the Count Landslide and Ero
sion osion Hazard Maps for
,_,/ guidance.) ' -h `d�, k-ctre
Ls1 ❑ [jl 7. 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 Count Seismic
Hazard Map for guidance.) v Y smic
`1
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
Co t Yes No/
El (fI 1. Agricultural Open Space Taxation Program, RCW 84.33
❑, ❑ 2. Open Space Timber Taxation Program, RCW 84.33, or Designated-Forest or Classifie 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:
► 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,dralnfields, wells & driveways. ► Project description
Scale 1"_
North Arrow
I state that I have answered the above,"hjfAilly to the best of my
yy knowledge.
C pp� Iicant/Owner -7, —/ g 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.