HomeMy WebLinkAboutRLC94-00966 - RLC Application - 4/28/1994 MASON COUNTY ,, 11
Date Received:`,
q.. 09(916 DEPARTMENT OF COMM UNITY'DEVELOPMENT6ee-
RESOURCE LANDS AND CRITtt^el ADCA_ CHECKLIST
The following checklist is designed to assist an applicant for a Building Permit, On-Site Sewage System
Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Line Adjustments, L
Segregations, Hazardous waste Permit, or Shoreline Permit in determining whether their property is affects
regulations under the Mason County interlm Resource Ordinance (77-931`. This checklist Is an impor
opportunity foridentifying eadv In the permit process whether there will be any environmental regulations affec
the proposed development.
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Owner_ ;;i&V. 4 ja k_V sa v,
Site Address -,,VC- Phone # -5
--� z 5 1 t 1( 3 city BP ( - zip 9 Owner Address__'P.o_ B o,� 111 at
Tax Parcel No. (Confirm with Assessors Office) 2 -City��.! State-�LZip g 5
5E Z -`� •�-- - 0 S2Q�2 Z Legal Description
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Project Description /. "
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Directions to site (Please attach map) SEE ,g&4:K�.,,- „
Please provi1,,a or attach a vicinity map w is nc u es cross streets, major roads, cree s, etc.
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Answer the following to the best of your knowledge. County wide maps showing
oin.w and resource lands are available for review at Mason County Department of Community Develome g
pnt, Plannin
w.o.r„ Department.
Do any of the following exist on this property or within 200 feet of this property) }
1. Saltwater shoreline or a lake 20 acres or Iarger7
❑ ❑ 2. Rivers stre
ams,
ems, or creeks with year-round flowT
❑ ® 3. Rivers, streams or creeks with Intermitter .t flow bu
t 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 circumstane,
support vegetation adapted for life in such conditions; such as marshes, bogs, and swamps. (See Cout,
Maps for guidance.)
❑ ® 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Ma sK
guidance.) s p
Q ❑ 7. Floodplains7 (See County Federal Emergency Management Maps and County Seismic Hazard Af,"
for guidance.)
❑ ❑ ® 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and Count S i
Hazard Map for guidance.) y e sr
You may be provided nuisance protections by the County for certain resource activltles. If you are enrolled in a
of the following programs:
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❑ Agricultural Open Space Taxation Program, RCW 84.33
0 ❑ 0 2. Open Space Timber Taxation Program, RCW 84.33, or Designated Forest or Classified Forest
RCW 84.34
• Coples are available at Mason County Department of Community Development for $5.00 each.
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SITE PLAN
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAF* IF POSSIBLE:
► Looadott•dlfnanelons of axbtktg i proposed property boundaries. ► ApproWmate slope of)and lgrade it direction),topography.
ide My lap4 aoease fnokrdatg,width of ad toed tight-of-ways&easements. P. Location of significant natural features(water bodies, rivers).
► Looata A atdattnp &proposed structures,draktfiaids,wags i driveways. ► Project description
Gals 1"- North Arrow
SEA A tJe-m Kc:F-0 P I O T /-O A P
I state that I have answered the above truthfully to the best of my knowledge. `'v- It
Applicant/Own Da
FOR OFFICIAL USE ONLY
U'llscent property,
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Sx;A,i L.... ,..9� �< .:t .`6cr'��ix. .a�l?2.s',2ii <.:S.lC:S..:, �d -.ari•..:� �A' 3 Y�
'here As a $40,00 a Iicadon fe
e rOf
PP the Resource eso r u Land & r C/tics!Are
as
s C heck!! .s t. ^Melee ch
ecks
cks payable to the Masc
County Treasurer, ,
when completed, this form becomes pert of the permit application.