HomeMy WebLinkAboutRLC94-00697 - RLC Application - 4/6/1994 It 6
MASON COUNTY
Date Received:
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DEPARTMENT OF COMMUNITY"DEVELOPMENT
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST (f S S�
The 4lowing checklist is designed to assist an applicant for a Building Permit, On-Site aPy
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Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Lia
Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their propertd
regulations under the Mason County Interim Resource Ordinance (77-93)*. This checklist is an importz
opportunity for identifying early in the permit process whether there wi
the proposed development. be any environ ental regu/ations affect.
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Site Address S OiP� city_- 'Z Zip
Owner Address /4,pd y/`�/_ 3 City=?/Z!4142, StatSAA
Tax Parcel No. (Confirm with Assessors Office)_29]cD7 - --rj 03? Legal Description_
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Project Description
Directions to site (Please attach map)_-5E :5- 3 -kJ) MZ Sla-i ka�,F•e_
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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 ere
ornei.i and resource lands are available for review at Mason County Department of Community Development, Planning
We only Department.
Do any of the following exist on this property or within 200 feet of this property?
o t Yes No
❑ ❑' 1. Saltwater shoreline or a lake 20 acres or larger?
❑ a 2. Rivers, streams, or creeks with year-round flow?
❑ ❑ 3. Rivers, streams or creek wit�rmit�tenntt flow but ar within a learly defined channel?
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V1 ❑ Q 4. Lakes or ponds less than 20 acres in size?
❑ ® 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.)
❑ Q 6. Slopes greater th n 15°o (8.5 degrees)? (See the County Landslide and Erosion Hazard M ps
guidance.) 5-—( p 5. �� 30- l,t� /o UAA �-�
❑ �-- 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard NI
for guidance.)
❑ ®,- 8. Seismic Hazard Areas? (Se County Federal Emergency Management Maps and County Seisr
Hazard Map for guidance.) / ,
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You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in a
of the following programs:
Cou t y Yes No
❑ Q 1. 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
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' Copies are available at Mason County Department of Community Development for t5.00 each.
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SITE PLAN
PLEASE SHOW THErFOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
► Location &dimensions of existing &proposed property boundaries. ► Approximate elope 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 effsting &proposed structures,drainflelds, wells &driveways. ► Project description
Scale 1"= North Arrow
I state that I have answered the above truthfully to the best of my knowledge.
4 Applicant/Own r Da
FOR OFFICIAL USE ONLY
Adjacent property.
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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.