HomeMy WebLinkAboutRLC94-0269 - RLC Inspections - 2/15/1994 MASON COUNTY Date F'eceived:
DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST 4' 41
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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 willbe any environmental regulations affecting
the proposed development' , fv
Owner_ L�-,i&.e / Phone #(t6) 6-2'�'- 1`T6-6
Site AddressG,� o ,� L. 46c ) n A LJ 7-70 kp City Zip
Owner Address_y 2.z o /9A+`' c lJ s",r,e 3 -S3S City State t ,- Zip 9g o 3 �,
Tax Parcel No. (Confirm with Assessors Office) 3 a a - r'3zv - o00o c� Legal Description_
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Project Description— a.� OL �o U� .,.�c� 20
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Directions to site (Please attach map)
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
omci.i and resource lands are available for review at Mason County Department of Community Development, Planning
uss oNy Department.
Do any of the following exist on this property or within 200 feet of this property?
Couoy Yw No
❑ 0 1. Saltwater shoreline or a lake 20 acres or larger?
9
❑ Q 2. Rivers, streams, or creeks with year-round flow? � wL,
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[{� ❑ Q 3. Rivers, streams or creeks with intermi ent� to but are within a clearly defined channel?
/ N£'- y� ��!0 if�S�DLOYM ..�� j4��L�
[�( p ❑ 4. Lakes or ponds less than 20 acres in size?
LEI 5. Wetlands: Areas that are inundated or saturated by surface water that.under normal circumstances
support vegetation adapted for life in such(coonndi 'ons such as marshes, bogs, and swemps. (See Coun jy
Maps for guidance.) G����G� / =I "t '& { "" ` er
❑ ❑ 0 S. Slopes greater than 15%(8.5 degre s)? (S�eea th "'County nd lidp and Erosion Hazard Maps for
guidance.)
[� ❑ 7. Floodplains? I�ee County Federal Emergency Management Maps and County Seismic Hazard Map
/ for guidance.) + �(
[� ❑ Q 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:
C t Yes No
❑ Q 1. Agricultural Open Space Taxation Program, RCW 84.33
❑ ❑ fc 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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Tahlxya River (the first small bridge.) Turn Left on Belfair-Ti,;,uya Road
(same name) . Turn Right at Tee Lake (next sight after glacks-rith Rd. )
co exactly 1-8-Miles. Turn Left'-, into Cady take approach road.
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nCODUMUt LAIVUS & GHI IICAL AREAS ,
SITE PLAN
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
► Location &dimensions of existing &proposed property boundaries. ► Approximate elope 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).
ti Locate all existing &proposed structures,drainfields, wells &driveways. ► Project description
Scale 1"_
North Arrow
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I state that I have answered thB abo truthfully to the best of my knowledge.
Applicant/Owner — /S- 1 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 completed, this form becomes part of the permit application.