HomeMy WebLinkAboutRLC94-0464 - RLC Permit / Conditions - 3/11/1994 ` Date Received: `C
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
bRESOURCE LANDS AND W4 CRITICAL AREAS CHECKLIST r�TZ�
T
he 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 properly is affected by
regulations under the Mason County Interim Resource Ordinance (77-93)•. This checklist is an important
opportunity foridentifying earlvin the permit process whether there willbe any environmental regulations affecting
the proposed development.
Owner_ �l f'G i tniC'a l I May) &tic� ���L F�pLwtG��I.1 Phone a()-o6 ) ,2-7S- S33 7
Site AKress City Zip
Owner ;Qr ss_p.p , 3OX 7r/�S I��1G,ir- City StatE4&AZip S
Tax Parcel No. (Confirm with Assessors Office)1,2-
U L L f�y 1 ; a
51—_ QOb6 SZ Legal Description
G o - II
Project Descriptions 8uJ/y; an SyLr Q� ,Li dh
Directions to site (Please attach map) F7(-()/v1 ►J SbtY� T'A � ,P7-n/! A,t/y M://
C97r) r�oh I/ L 02r.SOf'I L1f 46C7't R MO c<J
Please provide or attach a vicinity map whi h i eludes cross streets, major roads, creeks, etc.
t
Q(_W'5opi L K Tz U
S')or o
proptr`l
Answer the following to the best of your knowledge. County-wide maps showing general locations of critical areas
0111061 and resource lands are available for review at Mason County Department of Community Development, Planning
Use o,,,y Department.
IDo any of the following exist on this property or within 200 feet of this property?
Carr - Ycs No
❑ El-' 1. Saltwater shoreline or a lake 20 acres or larger? t
❑ � 2. Rivers, streams, or creeks with year-round flow?
❑ [�( 3. Rivers, streams or creeks with intermittent flow but ar�IIwi\\thin a clearly defined channel?
❑ [ ] 4. Lakes or ponds less than 20 acres in size? w
❑ [� 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, bops, and swamps. (See County
Maps for guidance.) b 3
❑ rff 6. Slopes greater than 5°
i 9 t than 1� /°U(8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.) 3 0)6 e/f 0
❑ i 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.) (
V 10
❑ [Z 8. Seismic Hazard Areas? (Se County Federal Emergency Management tvlaps 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:
� No
❑ 1. Agricultural Open Space Taxation Program, RCW 84.33
D
y ❑ 2. Open Space Timber Taxation Program, RCW 84.33, or Designated FoRARoricitsIMForest,
RCW 84.34
• Copies are available at Mason County Department of Community Development for 45.00 each.
r—
RESOURCE LANDS & CRITICAL AREAS
' SITE PLAN
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
P. location & dimensions of oxlsting & 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,dralnfields, wells & driveways. ► Project description
Scale 1"= �(� �E S& ---> North Arrow
C,o CA710 V7 • S
A
120 bb E
TNZ.
LLLC)
L
SolILJ �7(7ET�S
1 state that I have answere the above truthfully to the best of my knowledge.
Applicant/Owner — 9 — Date
FOR OFFICIAL USE ONLY
Adjacent property.
Ito 4
llkt g
Using County Resource Land Maps, this property Is desipnatod as:
Long-fern. Commaroial Fprest 4, Shoreline Master Program
�2 Inholding ;Land b. Goes not apply,
3. Mineral ReBqurce Land /I
Dote i` r c �y DGD
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 pert of the permit application.