HomeMy WebLinkAboutRLC94-00866 - RLC Inspections - 4/20/1994 Date Received:
MASON COUNTY
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DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST
I
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 foridentifying earlvin the permit process whether there will be any environmental regulations affecting
the proposed development.
Owner_&Sf Phone #( )
Site Address 22 Z. °l IJDl�jf1-4� �hi7 City Zip
Owner Address I U City_'_C A r1T(,>; State Zip9�11Z ,L831
Tax Parcel No. (Confirm with Assessors Office)32,2p570 0/)6;2 ni-S 2 6t&A'L Legal Description
Project Description I � CI�DIIJ -1n1(af�11 , .�'C�tGWIb'�/1' n �,�q,•, _
Directions to site (Please attach ma )
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Please provide o attach a vicinity map hich includes cross streets, major roads, creeks, etc.
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Answer the following to the best of your knowledge. County-wide maps showing general locations of critical areas
oineal 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?
Co t Yes No
❑ 1. Saltwater shoreline or a lake 20 acres or larger? 14,10
❑ 2. Rivers, streams, or creeks with year-round flow? Al)
❑ 3. Rivers, streams or creeks with intermittent flow but are within a clearly de 'ned channel?
❑ Q( 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 s ch c nditions; such as marshes, bogs, and swamps. (See County
Maps for guidance.) � �� C,y}, /�✓�"�J��
❑ 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.) _ �j�� five L�rG I S �C/ av L
[-] 7. Floodplains? (See County Federal Emergency Managemeht Maps and County Seismic Hazard Map
for guidance.)
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❑ ❑ 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.) /^W
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
Cou Yes 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.
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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-wage &easements. . Location of significant natural features (water bodies, rivers).
Locate all existing & proposed structures,drainfields, wells & driveways. * Project description
Scale 1"= North Arrow
state that I have answered the above truthfully to the best of my knowledge.
Applicant/Owner Date
FOR OFFICIAL USE ONLY
Adjacent property.
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�l tJS1119 county fiesCJumo Land Malis, till , litull oriy i� ui..si�9iaugv�; a,,
Long r�< C Af>t1n1QCLial I"orost �4. '`�hOrolhle t�la�tor F�rt� reatll
Inholdiiiq Land : Does not opply.
ll in rill Resource Land
_.
C�sltrs �" UCD
There is a $40.00 application lee 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.
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PROJECT INFORMATION
OWNER: Pat & Ed Wagner
PROPERTY ADDRESS: 22239 Northshore Road
Belfair, Washington 98528
ORIGINAL BUILDING
PERMIT: No. 10439
1981, Rbt. Sherry.
LEGAL
DESCRIPTION: That portion of Government Lot 3, Section 5,
Township 22 North, Range 3 West, W.M. Mason
County, Washington, more particularly described as
follows:
A circular tract of land having a radius of 60 feet, the
radial center of which is marked by an iron pipe which
is located 982.14 feet West and 2753.92 feet South of the
Meander Corner beign an existing steel axle.
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