HomeMy WebLinkAboutRLC94-0097 - RLC Permit / Conditions - 1/20/1994 Date Received:
�4''. MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
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RESOURCE LANDS AND CRITICAL AREAS CHECKLIST 3
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The following checklist is designed to assist an applicant for a Building Permit, On-Site Sewage System Sit(
Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Hazardous waste Permit, or Shorefint
Permit in determining whether their property is affected by regulations under the Mason County Interim Resourct
Ordinance (77-93)*. This checklist is an important opportunity for identifying early in the permit process whethe,
there will be any environmertal regulations affecting the proposed development.
Owner_ �.r-e wf .i f" C' Phone # d
Site Address _ \ City c, Zip �}
Owner Address City "Zlmw Statelktop
Tax Parcel No. 3 ` 1 - S _-' � Legal Description_
Directions to site (Please attach map)_
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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 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?
County Yea No
( ❑ m 1. Saltwater shoreline or a lake 20 acres or larger?
❑ ® 2. Rivers, streams, or creeks with year-round flow?
❑ 3. Rivers, streams or creeks with intermittent flow but are within a,clearly defined channel?
❑ [D 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 adapte for life in such conditions; such as marshes, bogs, and swamps. (See County
Maps for guidance.)
[�] ❑ ® 6. Slopes greater than 15% (8.55 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.) `_ 301,) & U
❑ [D 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard iviap
I for guidance.) VVID
❑ ❑ El 8. Seismic Hazard Areas? (See County Federal Emerg Management Maps and County Seismic
Hazard Map for guidance.) tw
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
Co Yea No
Er ❑ ❑ 1. Agricultural Open Space Taxation Prc, n, RCW 84.33
❑ ❑ 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 $5.00 each.
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RESOURCE LANDS & CRITICAL AREAS
SITE PLAN
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSS113LE:
► Location &dimensions of existing &proposed property boundaries. P. Approximate slope of land (grade &direction), topography.
P. 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.
Scale 1"= North Arrow
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I state that I have answered the above truthfully to the best of my knowledge.
Applicant/Owner �I� D
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FOR OFFICIAL USE ONLY
Adjacent property.
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There is a $40.00 application fee for the Resource !f-nd & Critical Areas Checklist. Make checks payable to the Ma:
County Treasurer.
When completed, this form becomes part of the permit application.