HomeMy WebLinkAboutRLC94-0297 - RLC Application - 2/22/1994 Date Received: 'Z Z
' MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST D-7-72-Nd-S3
Leg O $S
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 foridentifying earlvin the permit process whether there will be any environmental regulations affecting
the proposed development.
Owner. (r'q"n w.otis Phone 111 ) �`l"8.3ril,r
Site Address �.-3.30 Qg/�bci�� � City= Zip %7S3 L/
Owner Address City i State'(4� Zip
Tax Parcel No. (Confirm with Assessors Office0-2 / -S3 _ 00/�V Legal Description
Project Description
Directions to site (Please attach map) ZA c st-o r-e -- 13 v/ e F? -yl
o p S oy �h -7`�irr-c R i 1�fi�f� Pv�d o F Nu l d�S'a (off r o`, Op e sti f
_ i C
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
Official and resource lands are available for review at Mason County Department of Community Development, Planning
use only Department.
Do any of the following exist on this property or within 200 feet of this property?
Co t Yes No
❑ 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 are ith\�i a clearly defined channel?
El4. Lakes or ponds less than 20 acres in size? YW Lf N
❑ 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstances
support vegetation adapted for life in such condi ions; su h as arshes, bogs, and swamps. (See County
Maps for guidance.) [t,'� lj' /� n,� �
❑ (}] 6. Slopes greater
guidance.) t an 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
g o%J N mfle rjx PO rb*qh /"
❑ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.) Iv�4
,� ❑ �] 8. Seismic Hazard Areas? (See Codo unty eder I E ergency MaAv�
agement Maps and County Seismic
Hazard Map for guidance.) G
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
CoLity Yes No
❑ 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 /7
' Copies are available at Mason County Department of Community Development for $5.00 each.
Kt5UUHCt LANDS & CRITICAL AREAS
SITE PLAN
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
P. Lacatlon &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"= c;).y� =7
North Arrow
16-1
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s�ore� __
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I state that I have answered the above truthfully to the best of my knowledge.
-41"., Applicant/Owner �r Date
FOR OFFICIAL USE ONLY
Adjacent property.
�IP I*
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g, ty,Resource tend Maps, this property Is designated asC
1 Long-tern,. Ccamm rriat Fore t Shorolina Master Program
2. Mnholdltl Land . )OeS not apply;
Mill Rt source Land
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Coal e
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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.