HomeMy WebLinkAboutRLC94-0728 - RLC Application - 4/8/1994 Date Received: �4
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MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Atemo RESOURCE LANDS AND CRITICAL AREAS CHECKLIST
SAS
The following checklist is designed to assist an applicant for a Building Permit, On-Site Se ite
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 willbe any environmental regulations affecting
the proposed development.
Owner Phone
Site Address F - 2-20 1:,y .e City Zip
Owner Address _ City — State - Zip —
Tax Parcel No. (Confirm with Assessors Office),%Z/ � - - _Legal Description_
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Project Description 2l11:1\1C Cl— C.C, flcIA— C'�K,
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.
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Answer the following to the best of your knowledge. County,-wide maps showing general locations of critical areas
offlelsl 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 Yes No,
❑3( . 1. Saltwater shoreline or a lake 20 acres or larger? fLA)!
(� ❑ � 2. Rivers, streams, or creeks with year-round flow? t"U
❑ �D 3. Rivers, streams or creeks with intermittent flow but are within a clearly defined channel?
[� ❑ 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 adapted life in such conditions; such as marshes, bogs, and swamps. (See County
Maps for guidance.)
(� ❑ 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
/ guidance.) /,, '2� �5 s
❑/ ❑ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
7 for guidance.) t f)
(� ❑ ($ 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.)
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
Co t 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
' Copies are available at Mason County Department of Community Development for $5.00 each.
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SITE PLAN
PLEASE SHOW THE YOLLOWING 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, well* &driveways. ► Project description
Scale 1"= North Arrow
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I state that I have answered the above truthfully to the best of my knowledge. , i / ��//
Applicant/Owner z4/�/ �'! 't Date
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 Mason
County Treasurer.
When completed, this form becomes part of the permit application.
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