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HomeMy WebLinkAboutRLC94-01193 - RLC Inspections - 6/1/1994 1I r uate tieceived:c .C,4 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 7'UJV1 °(�-Gh?G/�} S�GHELL ?,gertJ� Phone #(204,) 282-7 3oto Site Address C,:t�sSE� 12�. 98 Owner Address �/0],�l 3(,�+ q�, w, City�1�7D✓✓ Zip .s-9y CityS� State AJ19 Zip 9W/4R Tax Parcel No. (Confirm with Assessors Office) _ Y�i 3& - 7(0 -_000/d Legal Description — Project Description -!rFPTI L: S`!ST CAA Directions to site (Please attach map) F"m t wy 3 ' vow Az api '46-4TE ii r t rJ G-oj t kW nD 4; ►tr Fr Sal; 4o Al S Please 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 Official and resource lands are available for review at Mason County Department of Community Development, Planning u.e ONY 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? ❑ ❑ (A 2. Rivers, streams, or creeks with year-round flow? ❑ ❑ 3. Rivers, streams or creeks with intermittent flow but are wit in a clearly efi c nel? ❑ ❑ 4. Lakes or ponds less than 20 acres in size? 01V111� ❑ ❑ 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.) ,n ,, ❑ ❑ 6. Slopes greater than 15% (8.P degrees),? (See the County Landslide and Erosion Hazard Maps for guidance.) s 1 S-"� ❑ ❑ 4 7. Floodplains? (See County F deraI E ergency anagement Maps and County Seismic Hazard Map for guidance.) GQC�! ❑ ❑ ( 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic Hazard Map for guidance.) {n"/11� You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any of the following programs: County Ye. No ❑ Q N 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. 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,dralnfields, wells & driveways. ► Project description Scale 1" _ North Arrow LIN 1,/ I state that I have answered the above truthfully to the best of my knowledge. Applicant/Owner s�._3 / j Date FOR OFFICIAL USE ONLY Adjacent property. hl4lk� pal �4�At,� 0-A Jik) 51n awl PIVA CIL(2& UsingCo�cnty Resource Lonci Maps, this propt:rty is tdcsidnatod as: Long-tern: 'f,orr�r��F;rr,j�lf orust _ -- -�, >horodirre Ma,;tur Prooram 2, Iidl,"' ill :and b Doe's not'apply, ........3. Mineral HCsourc:f. Land � y i > if �P �t D C D There is a $40.00 application fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Mason County Treasurer. Whan completed, this form becomes part of the permit application.