HomeMy WebLinkAboutRLC93-00226 - RLC Application - 11/8/1993 ,..:t: :. . Y �3—
®EPA1t1-NIENT OF COMMUNITY OEVELOPPOEN
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST
The following 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 Shore;'ine 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 earl��in the permit process v✓hetltrr there ���illbe anvenvir nmental regulations :ff cting
the proposed development. (�� �1✓� -� /,�'�.(,
Ovvner _�����{�Rl� ,�rSt _Phone Its '2G6) 2.757 37 a
Site Address City INCLf A, Zi
Owner Address_ R_�� _City State Zip
Tax Parcel No. (Confirm with Assessors Office)_ C2 - —1 S' - 0002_Legal Description`_
Project Description 1 ►'I(J�j
Directions to site (Please npattach map)_ N0r jr,);,, SA .,o1_R; L ,
m AnC1
Please provide or attach a vicini'y,m p 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
ornci.i 1 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
L^J A 1. Saltwater shoreline or a lalce 20 acres or larger?
(� ❑ [ 2. Rivers, streams, or creeks with year-round flow?
(� ❑ ❑� 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.)
❑ ❑ G. Slopes greater than 15% (8.5 degrees) (See the County Landslide and Erosion Hazard Maps for
uidance.) Z3Id?0
❑ ❑ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.)
❑ Seismic Hazard Areas? (See County Fedora! 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: %
Co' tY y- No
❑ ( 1. gricultural Open Space Taxation Program, RCW 84.33
�� ❑ 2. Open Space Timber Taxation Program, RCW 64.33, or Designated Forest or Classifiad Forest
RCVJ 84.34 '
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4 SITE PLAN 40
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
. Location &dimensions of existing & proposed property boundaries. s 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. o- Project description
Scale 1"= North Arrow
I state that I hav(�e, ,answerre�d the above truthfully to the best of my knowledge.
C lk�l�� 1'C ,I�`-� Applicant/Owner Date
FOR OFFICIAL USE ONLY
Adjacent property.
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rr term amma� la:i a 5t SfY4ralli�� ......
. krtEloidfnt land 6 Ipes no;t aPi?(Y
Marie.:. rat Resource Land
There is a $40.00 application fee for the Resource Land & Critical Areas Checklist Make checks payable to the /YI SO
County Treasurer. 17
171
When completed, this form becomes part of the permit cpplication.
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