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HomeMy WebLinkAboutRLC94-0698 - RLC Application - 4/6/1994 4 G `74 - 6iq � MASON COUNTY Date Received: ` DEPARTMENT OF COMMUNITY-DEVELOPMENT VV4 RESOURCE LANDS AND CRITICAL AREAS CHECKLISTSS The following checklist is designed to assist an applicant for a Building Permit, On-Site Sewage System S Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Line Adjustments, La Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affected regulations under the Mason County Interim Resource Ordinance (77-93)*. This checklist is an imports opportunity for identifying earlyin the permit process whether there will be any environmental regulations affect) the proposed development. 4)-o Owner \w (�LtC,� �� o ' Pcchnne, # 6 Site Address City a/vz I7�n Zip S-8� Owner Address__ . X �`J 3 City. /Foil State—kAZip g Tax Parcel No. (Confirm with Assessors Office) 2► Z.7 - 5 3 - co I O 4- Legal Description_ L OL 6- t) J Project Description " Directions to site (Please attach map) 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 ar( Official and resource lands are available for review at Mason County Department of Community Development, Planning uss only Department. Do any of the following exist on this property or within 200 feet of this property? comtl Yes No ❑ ©i 1. Saltwater shoreline or a lake 20 acres or larger? ❑ (Q/ 2. Rivers, streams, or creeks with year-round flow? PEl 3. Rivers, streams or creeks with intermittent flow but are withi _i" clearly defined channel? ❑ Qom' 4. Lakes or ponds less than 20 acres in size? �l 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstanc / support vegetation adapted for life in such conditions; such as marshes, bogs, and swamps. (See Cour Maps for guidance.) Z L.s`s,6 CwAR- 1(e0' 1&of [� ❑ Q' 6. Slopes greater than 15% (8.5 degrees)? (See the County L ndslide and Erosion Hazard Maps / guidance.) -1 5 — )S-�U IX ❑ C3--- 7. Floodplains? (See County Federal Emergency Manageme Maps and County Seismic Hazard M for guidance.) ❑ �}� 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seisr Hazard Map for guidance.) You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in a of the following programs: c nt � o F1. Agricultural Open Space Taxation Program, RCW 84.33 Q� ❑ �� 2. Open Space Timber Taxation Program, RCW 84.33, or Designated Forest or Classified Forest, RCW 84.34 • Copies are available at Mason County Department of Community Development for t5.00 each. • IILJ JUnLoF- LPAI'AL./J Ol 1,.I11111iHL Hr%CA0 ' ~ r 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. P. Location of significant natural features(water bodies, rivers). ► Locate all existing &proposed structures,drainfields, wells &driveways. ► Project description Scale 1"= North Arrow 1 I state that I have answered the above truthfully to the best of my knowledge. Applicant/Owner Da FOR OFFICIAL USE ONLY Adjacent property. .................... Gt#t;Ef4i-:i Ri a r.. �.a~ n...d.::. llg . ;•>�hi .. r. r.. .:i ::.c# ii ;::,.:;:>:::::;::<:;::.;:.,;..:.::..:.:;>;:.:::;.;::•::..:... .>:::::: �.��;.rrz;;�;Qrt�m�r�C�t 1~ar�s�: ;.;:<<.;;:::•:�.:>::. :;.�.;;•Sh.a.raltna:.M�s� . :. n ::::,:::>•:::>::••::;..:.:;:.;:::,:::::<.;;:...•.::•.�.•.;::Ithr >: : . .. : .:... . :;:: •. ;......... ;;:::;:.;:::;•:...:. rat ...... car Larlct.:;�:•>:::<:<:::;•>.;;: ....;;:<::_>:::::;•:..:::::.:.:•<�:::� :: •�;:::>::::;••:>:.•::::>:;::::;.; ;:•:.. ;;, D xi There is a $40.00 application fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Masc County Treasurer. When completed, this form becomes part of the permit application.