HomeMy WebLinkAboutRLC - RLC Application - 7/15/1994 uate neceivesu:
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 Sil
Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Line Adjustments, Lar,
Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affected t
regulations under the Mason County Interim Resource Ordinance (77-93)*. This checklist is an importar
opportunity for identifying early in the permit process whether there will be any environmental regulations affectir.
the proposed development.
Owner Plot t �d"J Phone #( ) `7.Z6
Site Address C- 2CIG ( AIA-NQ/,J C-L N�—E-AS 1 City-,-,PA k-�)i c Lj Zip C-j A
Owner Address S(J WIC City State Zip
Tax Parcel No. (Confirm with Assessors Office) 22-2 33 - a Z - U(IC)g2 Legal Description_
AD11\1(l 5(J4"J'y suyiu W cry
Project Description GAMC<-
Directions to site (Please attach map) -TO /yth( Q/� 66,-J 0q J (2-6 -Jl?\J L.45--?, '7m
IMAA J L.K 1)L C4-S Z TE10\) P!Gk i -10 e-� 64� Lzab o..j c-E�
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 arc
0HIL1.1 and resource lands are available for review at Mason County Department of Community Development, Planning
U..ony Department.
Do any of the following exist on this property or within 200 feet of this property?
Ea ,,lY y e. No
❑ QT ❑ 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?
❑ ❑ 'El 4. Lakes or ponds less than 20 acres in size?
❑ ❑ �j 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstanc
support vegetation adapted for life in such conditions; such as marshes, bogs, and swamps. (See Coui
Maps for guidance.)
❑ ❑ 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps
guidance.)
❑ ❑ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard h
for guidance.)
❑ ❑ 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seist
Hazard Map for guidance.)
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in
of the following programs:
C—ly 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 $5.00 each.
SITE PLAN
PLASE 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. ► Location of significant natural features(water bodies, rivers).
► Locate all existing & proposed structures,drainflelds, wells &driveways. ► Project description
Scale 1 "= North Arrow
wAcac-
state that I have answered the above truthfully
ul y to the best of my knowledge.
Applicant/Owner 7 f/�(mil L/ Dat
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 Maso.
County Treasurer.
When completed, this form becomes part of the permit application.