HomeMy WebLinkAboutRLC94-0921 - RLC Application - 4/25/1994 UdIC CI.CI
MASOPI*-:OUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
E LANDS AND CRITICAL AREAS CHECKLIST
The fol%win e k 's designed to assist an applicant for a Building Permit, On-Site Sewage System Sir
Evaluation an��i p sourmit, Access Permit, Land Modification Permit, Boundary Line Adjustments, Lan
Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affected b
reguA�u� my Interim Resource Ordinance (77-931*. This checklist is an importar;
opportunity on en i ying e r i fie permit process whether there will be any environmental regulations affectin
the proposed development.
Owner 7p e5' /(/OTCh Z-/oAa&s' 1�• Phone
Site Address for 44 Z)iv --1 7 S �s ova City Q��Fi-��2 Zip
Owner Address .3739 Scwr� WeZT City_Z:�e F401J State JJ,4Zip 963 3/Z-
Tax Parcel No. (Confirm with Assessors Office) /o233cas - - .¢Q Legal Description_
Lor -Y� L,i v - 7 4 ,9,eiL Co v
Project Description Z�_S1_G;1VLJ r A3,4P A (c�,,,�S��i1GI7v�•
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 area:
Official and resource lands are available for review at Mason County Department of Community Development, Planning
u.e ordy Department.
Do any of the following exist on this property or within 200 feet of this property?
C � No i
(�J/ 1. Saltwater shoreline or a lake 20 acres or larger?
❑ [R 2. Rivers, streams, or creeks with year-round flow?
❑ a", 3. Rivers, streams or creeks with intermittent flow but are within a clearly defined channel?
[71 ❑ [� 4. Lakes or ponds less than 20 acres in size?
❑ E�' 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 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.)
❑ EK 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 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:
Cou Ye. 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
Copies are available at Mason County Department of Community Development for $5.00 each.
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. ► Location of significant natural features (water bodies, rivers).
► Locate all existing & proposed structures,drainfields, wells & driveways. ► Project description
Scale 1"= North Arrow
SEE A T�PrcJ-) Sf 1EET.l
I state that I have answered t above truthfully to the best of my knowledge.
Applicant/Owner Dat
FOR OFFICIAL USE ONLY
Adjacent property.
f V -
A�
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Ustng :ot�nty RSqu(rcQ 4nc1 Maps. this p>!operty ( cf5�g �d a:s�
1, �prig:tarir Ammar lot l=ores , Shprvl)n� Mister pr�9..
„� Inholdln Lead, 6 boss riot apply
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There is a $40.00 application fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Maso:
County Treasurer.
When completed, this form becomes part of the permit application.