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HomeMy WebLinkAboutRLC94-0135 - RLC Permit / Conditions - 1/26/1994 Date Received: I Z • �4 MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT `i -3 :4 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 Shoreline 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 early in the permit process whether there will be any environmental regulations affecting the proposed development. Owner (L _ a" Phone # Site Address 6f^`-�c� m5vy (C-1 La�� City �e rrl Zip 8�`d Owner Address t b t ���x 'tom 5 City Bf Ili StateW`( C' ' Zip _G) Tax Parcel No. (Confirm with Assessors Office) j a 3 3 1 -�_- C io i S' Legal Description_ D i J 1�_ l b+ q15_ Pea. 0(3 c� Project Description 1 Qom; hb_e.,_ v Directions to site (Please attach map) LI +J f`p-� -iL> C "c cz.SS - L ( r1-�-t 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 areas ofnci.i and resource lands are available for review at Mason County Department of Community Development, Planning use ONY Department. Do any of the following exist on this property or within 200 feet of this property? county Yes No El ❑ Q 1. Saltwater shoreline or a lake 20 acres or larger? ❑ ❑ 2. Rivers, streams, or creeks with year-round flow? 6 -0 ❑ ] 3. Rivers, streams or creeks with intermittent flow but are within ��aAAclearly defined channel? yVU ❑ ] 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.) 1 ❑ ❑ �J 6. Slopes greater than 15% (8.5 degrees) (See the County Landslide and Erosion Hazard Maps for guidance.) 3, S ")d 4--K� ,❑ ❑ �[] 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map for guidance.) (//"tk .� ❑ [� 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: Count Yes ,No ❑ [] 1. Agricultural Open Space Taxation Program, RCW 84.33 4/ ❑ ] 2. Open Space Timber Taxation Program, RCW 84.33, or Designated Forest or Classified Forest, RCW 84.34 f ` Copies are available at Mason County Department of Community Development for $5.00 each. ►►�vvv►►va.. ��►�✓V vC Vl►t l lVP1L. P111Lr1►.7 SITE PLAN PLEASE 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). P. Locate all existing & proposed structures,dralnfields, wells &driveways. P. Project description Scale 1"= North Arrow 1 l I state that I have answered the above truthfully to the best of my knowledge. Applicant/Owner Date FOR OFFICIAL USE ONLY Adjacent property. :.;:...; isin �qunty Resource f,and Ma �s, #his prgpert iS designated as: 1 Y 1. laray-tarn: Commercial Forest 4, Shoreline Mast ar I�royrm . Ir�holditiy land a. 'toes not apply. 3. Mineral Resource Land N.-3 , } Ire ©ate DCd 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.