HomeMy WebLinkAboutRLC94-01327 for BLD94-01024 - RLC Application - 2/20/1994 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 early in the permit process whether there will be any environmental regulations affecting
the proposed development,
Owner g /� Phone #(2-06-)9`/9-5"781n
Site Address�z,Z rM%leC Nary-h SHvre QQ HE. 20 i ' City .1 p —
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Owner Address P G , /SGX /G Z, I City J�;SfiG�uRk State fff Zip1r9OL7 _
Tax Parcel No. (Confirm with Assessors Office) 3 A X 0 7 - so _ 009 (3 Legal Description_
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Project Description &Om-e e- &4rcue S'//oacT PLAT 41766
Directions to site (Please attach map) Z e S Frc All 9 2 \04Ir
or °ra, s ore m 5 r-r Lef 7- N GO' /Jfi1'ew'f
M' IJST SN M oN SIGN Or;,,e wnY E.9gle 0 W-TTH
Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc. r
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Answer the following to the best of your knowledge. County-wide maps showing general locations of critical areas
onbw and resource lands are available for review at Mason County Department of Community Development, Planning
U. oNr Department.
Do any of the following exist on this property or within 200 feet of this property7
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❑ � 1. Saltwater shoreline or a lake 20 acres or larger?
❑ ❑ 0 2. Rivers,streams,or creeks with year-round flow?
❑ P1 ❑ 3. Rivers,streams or creeks with intermittent flow but are within a clearly defined channel?
❑ ❑ P 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.)
❑ ❑ 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:
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❑ 1. Agricultural Upon 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
PLI*ge SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
.Location&dimensions of mdating&proposed property boundaries. .Approximate slope of land(grade&direction),topography.
•Identity legal earns Inclu
ding,width of all road rightot-ways,&easements, a Location of sigrdQcant natural features(water bodies,rivers).
•lost.ale adsting&proposed structures,drainflalde,wells&driveways. .Project dsiorlption
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I state that I have answered;th y to the best of my knowledge. �1AL
Applicant/Owner Data
FOR OFFICIAL USE ONLY
Adjacent property.
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There S .O Ucadon lee for the Resource Land& Critical Areas Checklist. Make checks payable to the Mason a
County Treasurer.
When completed,this form becomes part of the permit application, i
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MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST
Permit Numb rr;2
(-M ` t6� RLC#
Owner '16"u- `
Parcel Number 3 t ✓✓ —(JV-L
❑ 1. Saltwater shoreline or lake 20 acres or larger?
Name of Water Body
❑ 2. Rivers, streams. or creeks with year round flow? -- QUy1 d ff
Type of Other Water
6
❑ 3. Rivers, steams or creek with intermittent flow but are within a clearly defined channel?
❑ 4. ^WLakes 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.
6.. Slopes greater than 15% (8.5 degrees)? On Landslide Hazard Map? I S Fo L o qn
\vU % of Slopes
❑ 7. Floodplains?
❑ S. Seismic Hazard Areas? CV�,`\t\ le.S Coas{a` Zone_ A tlG'S
❑ 9. 'Agricultural Open Space Taxation Program?
❑ 100)Open Space Timber Taxation Program, or Designated forest or Classified Forest?
❑ 11. Site has no Resource Lands or Critical Areas.
Comments:
GYM Mv Da Q A-2 ocA: (')I14ai l- HOUSC
C,XJX2e-c 65 SI;U P
Authorized Signature Date