HomeMy WebLinkAboutRLC94-1051 - RLC Inspections - 5/11/1994 MASON COUNTY I I V'IGf-
DEPARTMENT OF COMMUNITY DEVELOPMENT
. T�♦ 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 t77-93)*. This checklist is an important
opportunity for identifying earlyin the permit process whether there will be any environmental regulations affecting
the proposed development.
Owner_ 5T? )r_tn J G 5Kb ate, Phone #( Zo6 ) Z 75--06C/V
Site Address_ 1]F" 991) Lae.,cAn yd —City--BE I gait , Zip 9$�
Owner Address_/_ f(5 t 6_0',fler f rye, f L,cJ, Citya��i�r/�/) State Tax Parcel No. (Confirm with Assessors Office}-� I
2►�3 I -�1__.__CCdd,_Legall Description_
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Project Description A)(c,J kZy'k
Directions to site (Please attach map) v
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Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc.
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Answer the following to the best of your knowledge. County-wide maps showing general locations of critical areas
o(n.i.r and resource lands are available for review at Mason County Department of Community Development, Planning
U..o.rY Department.
Do any of the following exist on this property or within 200 feet of this property?
Co Yes No 1. Saltwater shoreline or a lake 20 acres or larger? 1n14)
❑ ❑ 2. Rivers, streams, or creeks with year-round flow? Ui.t)
❑ J 3. Rivers, streams or creeks with intermit
tent flow but are within a clearly defined channel?
❑ [� 4. Lakes or ponds less than 20 acres in size? VLI)
❑ IX 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.) �tt
❑ ( 6. Slopes greater than 15% (8.5 degrees)? (See the Count
y Landslide and Erosion Hazard Maps for
guidance.) 2>—(.t�
❑ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.) [vV
❑ 8. Seismic Hazard Areas? (See County Federal EmergencyManagement
Hazard Map for guidance.) en g gent Maps and County Seismic
�l,16
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
U 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
Copies are available at Mason County Department of Community Developmont for 05.00 each.
51 I C r'LAIV
PL9ASE'SnOW 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 feature@(water bodies, rivers).
► boats all existing &proposed structures,dralnflelds, wells &driveways. ► Project description
Scale 1"=_?0 North Arrow
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I state that I have answered the above truthfUlly to the best of my knowledge.
Applicant/Owner Date
FOR OFFICIAL USE ONLY
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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.