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HomeMy WebLinkAboutRLC93-0400 - RLC Application - 11/23/1993 0DMASON COUNTY Date Received:_1/- Z 7 - S' � DEPARTMENT OF COMMUNITY DEVELOPMENT RESOURCE LANDS AND CRITICAL AREAS CHECKLIST 003 3 Th 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 early in the permit process whether there will be any environmental regulations affecting the proposed development. p 1 NFO. Owner_ -7_a yc �r �b�,Q,l�t. S Phone #(,706 ) y.2 7-0999 Site Address F .S'63 /LI/K�Cs�so,�y Poe City �i7z�LPov Zip g' Owner Address �/2 �o-Y 2?S' City S",,eL7a-.c/ Statell7.4zip ZED mo Tax Parcel No. (Confirm with Assessors Office) 3.Z /317r - - 94©YC7 Legal Description_ �X�BNz�e.v of ��w n,,w,r7t sF ,{/.�i/ ,,R.,t.. ,.t Sic �y 4e�uiys �n.2l .f/eL71, �atG e 3 sver�➢` tv/Ll v Project Description 'DR",r2_IV Alox3fL Directions to site (Please attach map) Awray Lt. 4( Ac—AT /,,rlc Te N1 KKel Sow At R/447- Elio oft A .1 72, 0R1yy&&*/ ml ,(�f?' s7RAgA7- 2r_, , R77 �s �- Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc. __&vp 3 15i= a� �,w /�iq�� tk/f4121 a Po�,rs 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 Yes No 1. Saltwater shoreline or a lake 20 acres or larger? , [ - ❑ © 2. Rivers, streams, or creeks with year-round flow? s� ❑ / 3. Rivers, streams or creeks with intermittent flow but ar within a clearly defined channel? Vv" 6 ❑ ] 4. Lakes or ponds less than 20 acres in size? f ❑ V 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.) ❑ ❑ ❑-.. 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.)�r You may be provided nuisance rotec"k y th Y p p y the County for certain resource activities. If you are enrolled in any of the following programs: County Ye, 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 55.00 each. RESOURCE LANDS & CRITICAL AREAS -qqqqq 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). ► Locate all existing & proposed structures,drainfields, wells &driveways. ► Project description Scale 1 "= / S F/ North Arrow C <\ y v NC, 0 RePA 5eP �to ,\0 I state that I have answered the above truthfully to he best of my knowledge. A licant �-02A -- 3 Date P P wne / 9 FOR OFFICIAL USE ONLY Adjacent property.$4,11t t ������ �� OK po, Using County Rot;ource Land Maps, this property is designated as: _ _._._.1 . Loris term Commercial Forest 4. Shoreline Master Program 2. Inholding Land 5. Does not apply. 3. Mineral Resource Lan h ate ....;. 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.