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HomeMy WebLinkAboutRLC93-00444 - RLC Application - 12/6/1993 Date Received: I Z 'G q3 MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 3S y 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. ' D;q;•l�l �^9er Owner LCJL e,sroE Lie elonmdj (or1 orA_{••ovx Phone #(7-66 ) 866-s7-31 Site Address E fib© Re o City She_lfa'1 Zip G(a_s-gy Owner Address $2l i.st City <SIdh- State WA Zip 9yyel Tax Parcel No. (Confirm with Assessors Office) 37- 137- ___ 32- - y004y tj Legal Description_ Lo f- H o F sb r} P&t ,* z z-7z fecor0�o 3--2.6 -113 Project Description S:,QIe- FAA":Iv Directions to site (Please attach map) 13r0',knA1,E Rtr}� �c fe.lce., Qonb — czcro s .5 frref` Fro.>1 S•k�neb;�u� en�ranc� 6��h. Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc. 3roc.k le E RoAn J.,,o, S janQbr'Wr Y x 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 u.a or4y Department. Do any of the following exist on this property or within 200 feet of this property? County Yea No ❑ ❑ 0 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 a1clearly defined channel? ❑ ❑ 4. Lakes or ponds less than 20 acres in size? ❑ ❑ M 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.) ❑ ❑ [�9 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for guidance.) ❑ ❑ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map for guidance.) ❑ ❑ [71 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 Yea No ❑ ❑ 0 1. Agricultural Open Space Taxation Program, RCW 84.33 ❑ ❑ 0 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. r t RESOURCE LANDS & CRITICAL AREAS 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. ► Idantlfy legal access including,width of all road right-of-ways&easements. ► Location of significant natural features(water bodies, rivers). ► Locate all existing &proposed structures,dralnfields, wells &driveways. ► Project description Scale 1"= North Arrow I state that I have answered the above truthfully to the best of my knowledge. Applicant/Owner Date FOR OFFICIAL USE ONLY Adjacent property. > 1:1G�unxy;I > SgI.rGH'4ar�tl Maps, phis:p opertY 1. .Lang ff�YrYt �arnmercf�i �a�est •`".`°` '�° p.. 'Shorellrte MasY�r Prt7�ram .. Irth41..drn land €'€': ':' ""`.; <' .::>< : :: .:.:.<..< < >:< :::':;:<.;::::>< 8 C]ges not µ M►nera! Resource Land 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. i r y� 2� �=j E 1� W w r ►70 t yew S, st p�r� a � iJ O E `/60 �'Qvts ch J�o ark Pr.✓.4 tr Got U hor 7 �ICCT 2 z 7zi lea-�zI1 32132 - 3Z - `looyl-1