HomeMy WebLinkAboutRLC94-0900 - RLC Application - 11/5/1993 ateReceived: 1
MASON COUNTY q . ZZ -�(q
PARTMENT OF COMMUNITY DEVELOPMENT
ESOURCE LANDS AND CRITICAL AREAS CHECKLIST I
he following checklist is designed to assist an applicant for a Building Permit, On-Site Sewag=
valuation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Line Adjustments, Land
egregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affected by
egulations under the Mason County Interim Resource Ordinance (77-93)*. This checklist is an important
pportunity for identifying early in the permit process whether there will be any environmental regulations affecting
)e proposed development.
)wner 1,a4Kj5' j ,VA7ST, 60 Phone #( 20G) q;?G 70
'ite Address e. i o 0FV6_A&gE,aW btZ. City Sal rv.✓ Zip fo5wy
5wner Address P-0• Ow /l City_S/%�iaro,J StateUh-Zip 581Ycl
-ax Parcel No. (Confirm with Assessors Office) 3:2/ 3 q - 00020 Legal Description_
S,144&3 13oW l.ArtLt il o T 10
'roject Description S'b(>T1c- r;UT-'. ,ILr' aeS f otr up
)irections to site (Please attach map) r—PW , j" V 33 LET o Q JL**J', J L;J4-Kt Ka 7V
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lease provide or attach a vicinity map which includes cross streets, major roads, creeks, etc.
Answer the following to the best of your knowledge. County-wide maps showing general locations of critical areas
,1e,al and resource lands are available for review at Mason County Department of Community Development, Planning
e Only Department.
Do any of the following exist on this property or within 200 feet of this property?
�ounly Ye No
] 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 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.)
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:
unty Yes No
Fl 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.
MCJUUhL t LHIVUJ LSt Uhl I IUAL AhtHJ
SITE PLAN
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
Location &dimensions of existing &proposed property boundaries. P. 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, wells &driveways. P. Project description
Scale 1"= Zo North Arrow_
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state that I have answered the above truthfully to the best of my knowledge.
Applicant/Owner 11— �" 3 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 completod, this form bocomos part of the permit application.