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HomeMy WebLinkAboutRLC94-01322 for BLD94-00999 - RLC Application - 7/12/1994 Date Received: MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 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 (77-93)*. This checklist is an important opportunity for identifying earlvin the permit process whether there will be any environmental regulations affecting the proposed development. Owner J�W/O'g St AA0 nD 154C-"V r/Q-&-&oe`t Phone #(2r)6) Site Address J6 - Z00 57M tJL r�21 ADZ �t- City t5'#q&(--?0A) Zip F95-'9Z- Owner Address Z© ZD �l_ S'r`, City State WA Zip 985 c4't- Tax Parcel No. (Confirm with Assessors Office).327- /- - 2- �r'o� �� Legal Description_ 1-0 Z- -Z / - Project Description cw r7'E SE r- ct vN�rti Directions to site (Please attach map) iUO2YH tit R. . - 2 r &rt 7- 01.) J t-: o S e4 E 770 L �T /Y T - /S ( B 2l aQ 1�L , TU G'tj-v O CC1 L -�� �i4t mN 2rGff! Please provide or attach vicinit map which includes cross streets, major roads, creeks, etc. S,mia 69, t"L- iN 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 ❑ No -- 1. Saltwater shoreline or a lake 20 acres or larger? ❑ ❑ 93-'� 2. Rivers, streams, or creeks with year-round flow? ❑ ❑ El"" 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 for 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.) ❑ ❑ 231"' 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map for guidance.) ❑ ❑ 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: County Yes No ❑ 0 E3-- 1. Agricultural Open Space Taxation Program, RCW 84.33 ❑ ❑ E�� 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. f1CJUUf1VC LNiVUJ U bill! I IUAL AMCHJ SITE PLAN PLEASE SHOW 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 features(water bodies, rivers). P. Locate all existing & proposed structures,drainfields, wells &driveways. ► Project description Scale 1"= North Arrow 35 �1 P,'� v� state that I have answered the above truthfully to the best of my knowledge. 2e J2 Z%� Applicant/Owner Z y Date FOR OFFICIAL USE ONLY Adjacent property. Using County ft e Resource Land Maps,ps, this property' tart j s designated na#ec� a s: ;:: >;: :s:>;.>::>:::::.;;:;:>:;>:>.;;::::>::::<:;:: .3 : 10 L rio jornt Crnmsrojal I~AreSt � Sherdfirre lVlat�ter`Prtarf�� .....::.....: �.2. lnholding Land 5. Does not apply< 3. Mineral Resource Land Da t :.. IX 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. � p r MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT RESOURCE LANDS AND CRITICAL AREAS CHECKLIST Permit Number y ( RLC# Owner L.� kw� Z n Parcel Number C� � � Y ❑ 1. Saltwater shoreline or lake 20 acres or larger? tv� Name of Water Body ❑ 2. Rivers, streams. or creeks with year round flow? -� Type of Other Water ❑ 3. Rivers, steams or creek 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 sup,Rort vegetation adapted for life in such conditions; such as marshes, bogs, and swamps. ❑ 6.. Slopes greater than 15% (8.5 degrees)? On Landslide Hazard Map? -- '2 " 91 ,� % of Slopes Elr/),7. Floodplains? 6 t "��" � vW I ❑ 8. Seismic Hazard "Areas? U vul ❑ 9. Agricultural Open Space Taxation Program? U v ❑ 10. Open Space Timber Taxation Program, or Designatef r�st or Classified Forest 11. Site has no Resource Lands or Critical Areas. vQ vk Comments: fii li Authorized Signature Date