HomeMy WebLinkAboutRLC93-00543 - RLC Application - 12/23/1993 ' Date Received:—FL -L3 ' 1
MASON COUNTY
L'�ARTMENT OF COMMUNITY
TY DEVELOPMENT
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RESOURCE LANDS AND CRITICAL AREAS CHECKLIST 613
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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 Shoreline Permit in determining whether their property is affected by
regulations under the Mason County Interim Resource Ordinance (77-93!*. This
ortant
opportunity foridentifying earlvin the permit process whether there willbe any environmental regulations affecting
the proposed development.
Owner d�
rc L ^/S'12U�T/�tG Phone #( 6) �>>lyS`/,6
Site Address -79D /V ��cd�h,/ (�-,�N ,Pd City_�F.�l•�' Zi
Owner Address_ /�/ L��,E G��/p p
City��10"V -o YState"Zip"-?/ 2
Tax Parcel No. (Confirm with Assessors Office),1�� 3 /�tl�_�_��- _Legal Description
Project Description
Directions to site (Please attach map)
ell
Please provide or
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Answer tf
ornCi,i and resou Q :ritical areas
We only Departmei 'tanning
Do any of
Co nt Yes No.
Ld ❑ '[ 2. Rivers, streams, or creeks with year-round flow 1
❑ [ 3. Rivers, streams or creeks with intermittent flow but are wi hin I`^ a clearly defined channel?
❑ 4. Lakes or ponds less than 20 acres in size? A ,\
�1 ❑ 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstances
support vegetation adapted life in such conditions; such as marshes, bogs, and swamps. (See County
Maps for guidance.) �0
E( ❑ [k 6. Slopes greater than 15% (8.5 degrees)? See the County Landslide and
guidance.) /` Erosion Hazard Maps for
❑ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.)
❑ 8. Seismic Hazard Areas? (Se County Federal Emer enc
Hazard Map for guidance.) ( g Y Management Maps and County Seismic
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
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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
i Copios are available at Mason County Department of Community Development for $5.00 eacl). v
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SITE PLAN
iSE 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,drainfields, wells &driveways. ► Project description
Scale 1"=
North Arrow
I state that I have answered the above truthfully to the best of my knowledge.
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0 Applicant/Owner /-y a`3/� 3 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.