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HomeMy WebLinkAboutRLC3261 - RLC Inspections - 11/8/1993 Date Received: ( � C> b - 3 MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT RESOURCE LANDS AND CRITICAL AREAS CHECKLIST 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,t regulations under the Mason County Interim Resource Ordinance (77-93)*. This checklist is an importai opportunity for identifying early in the permit process whether there will bean yen vironmental regulations affectir. the proposed development. Owner 'I s,I `� ilC 0((n rL Phone #(2©(0) Site Address c..t ADS CC'�vc ��tY �� L pT 12 City i3 c 17 +l� Zip Owner Address I Cl I�c�x - 7 City Sf4�L(L/V State(� Zip Tax Parcel No. (Confirm with Assessors Office) `" () Legal Description_ 1--) y lC,i (Z 1 �O LDS Cc' yc- Project Description /Vr-74� gowS Directions to site (Please attach map)_ NO;.Tq S Nt,�-E TO SA N(�) Ni L(— r� tJ ?��►\( _><-/ C, c•, .i C L Q IZS(:t,&t Lk ( L a b 'R, ck N ( �--E7— C.©.i (OM Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc. sk" f J L C. 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 Use Only Department. Do any of the following exist on this property or within 200 feet of this property? Count Y NJ' ❑ 1. Saltwater shoreline or a lake 20 acres or larger? [;K ❑ 50 2. Rivers, streams, or creeks with year-round flow? ❑ [�J 3. Rivers, streams or creeks with intermittent flow but are withrhin-�a clearly defined channel? ❑ 4. Lakes or ponds less than 20 acres in size? i� V A) [�.- ❑ 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.) lll,�; E�/- ❑ F4 6. Slopes greater than 15°0 (8.5 degrees)? (See the County Landslide nd Erosion Hazard Maps foi guidance.) 5�7C �,✓��{,�,�, � f� ( 5 �� � .ti�� ti�M V-7,� a ❑ � 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Mai for guidance.) h,'A ❑ [� 8. Seismic Hazard Areas? (Se\e County Federal Emergency Management Maps and County Seismic Hazard Map for guidance.) Lt; You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any of the following programs: Cou Yes; No ❑ ® 1. Agricultural Open Space Taxation Program, RCW 84.33 [[J ❑ 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: ► 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. P. Location of significant natural features(water bodies, rivers). ► Locate all existing & proposed structures,drainfields, wells & driveways. ► Project description Scale 1"= North Arrow I state that 'hav answ red the above truthfully to the best of my knowledge. Applicant/Owner II r > , Datc FOR OFFICIAL USE ONLY Adjacent property. VO(C I'�vel Using County Resource Land Maps, this 'property is designated as; 1, Lang-tear Commercial Forest 4. Shoreline Master program' 2. Inholding Land 5. Roes not apply. 3. Mineral Resource Land ;: .'.Qate t om~ .._._6J CD There is a $40.00 application fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Masor. County Treasurer. When completed, this form becomes part of the permit application.