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HomeMy WebLinkAboutRLC95-00001 - RLC Application - 12/27/1994 Date ReceivedA 2 MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT RESOURCE LANDS AND CRITICAL AREAS CHECKLIST Wvs The following checklist is designed to assist an applicant for a Building Permit, On-Site SewagSite 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 Lv 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 Dry) Phone #GW& $7/ -75-Z I Site Address A52pr l CoJ L.ot. City 1�3e.lFru r Zip 9$ Sz,Q Owner Address 1 f c5E. City /t / Statel64.1Zip '1'5—T4 eo, Tax Parcel No. (Confirm with Assessors Office) /2 330 - DO()0 y Legal Description_ Project Description f'?.t.AA Directions to site (Please attach map) Turn ¢FP on to r Le-4 NE arsm LK. Dr, c to dMsrn DR• urt h lof o Please provide or attach a vicinity map which incl des cross streets, major roads, creeks, etc. IIE. K c.w��:r� T ti t✓ 7< 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 ONY Department. Do any of the following exist on this property or within 200 feet of this property? County Yes No ❑ ❑ ,r 1. Saltwater shoreline or a lake 20 acres or larger? l'Ali El [] 2. Rivers, streams, or creeks with year-round flow? I?4—All ❑ ❑ 3. Rivers, streams or creeks with intermittent flow but are within,a clearly defined channel? �❑ ❑ 4. Lakes or ponds less than 20 acres in size? ❑ 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.) ❑ 6. Slopes greater than 1 % (8.5 degrees)? (See the County Landslide and Erosion Hazard Mans for guidance.) l/�/A q l/74D 0 ❑ ❑ [ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map i for guidance.) ❑ © 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: ount Yes No [ ❑ [J 1. Agricultural Open Space Taxation Program, RCW 84.33 ❑ ❑ 0 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. ► Project description Scale 1"= North Arrow f D-7, � l jot-,-- A. © p ti 4d lr 1)'o state that I have h answered v e the above truthfullyto the best of m knowledge. Y 9 Applicant/Owner Date FOR OFFICIAL USE ONLY Adjacent property. ke/ 1�, l� r, M�fi';:o-' - �qv Ustnq County Rast�tfrce Lartd Maps, this property �a designated as, ... .::.. :..;. ..::::. 1. l Ong-tam CQrrlmers1 LI FareSt Shoreline Master Prograrn ::.:.. .:..: . .:.:::. 2, Inholdin Land 5. Does not apply. , 3. Mineral Resource Land > �« ..:.::...:... 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.