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Home My WebLink AboutRLC94-00320 - RLC Application - 2/14/1994 Date Received: 4?1� q_1/ 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 early in the permit process whether there will be any environmental regulations affecting the proposed development. Owner iG�i! /9 f0 C` / c-1 e f� Phone ��G S 7 o e #f ) 7 �/ Site Address 3n I Mawr, I� —�i;�1 s, City 1.)r— Zip Owner Address 41F 1� elA 4, , City cYD�� tate Zip E e Tax Parcel No. (Confirm with Assessors Office) r�9�/�y s -�u��y S RAC # 6 Legal Description_ Project Description o Directions to site (Please attach map) oe > S Please provide or attach a vicinity mapioypjF}!20f cross streets, major roads, creeks, etc. L__I � d 50 yl I'. E,7 t 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 Use orgy Department. Do any of the following exist on this property or within 200 feet of this property? C nt w o C5 1. Saltwater shoreline or a lake 20 acres or larger?RaSon JQ,&/ ❑ l 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 ❑ 4. Vkes or ponds less khan 20 cres in size? ,c 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.) ❑ f 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for guidance.) L�J�15 ❑ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map �h(e for guidance.) 1U ❑ 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: CoUnty yes 00 ' 1. Agricultural Open Space Taxation Program, RCW 84.33 ❑ ✓✓✓5k��` 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. RESOURCE LANDS & CRITICAL AREAS 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,drainfields, wells &driveways. ► Project description Scale 1"-- North Arrow I state that I have answered the above truthfully to the best of my knowledge. -� Applicant/OwnerDat FOR OFFICIAL USE ONLY Adjacent property. / S v ,a0 ti ....e........,..�,. 4 U in County R( ,g yource Land Maps, this property is designated a i. Long-tern-, Commercial Forest 4, Shoreline Master !'rogram . Inheldint Land 5. Goes not apply, .::. Mineral R% 3ociree Land DE to � DCD 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. Date Received: 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 earlyin the permit process whether there will be any environmental regulations affecting the proposed development. I Owner W f (I ; Orr, 1/"? `f'- �C Phone #(x'6 ) 7S J 7 / `f Site Addre 3U� C} fYt so .-a i'ti�� ;• =zrsf City ►-�n1c� r:,�` Zip Owner Address "7 �//�,'` A)6 K+L LA) n r% , �r e,� CityZ o 0 6,i-,Stat"v"_Zip ` Tax Parcel No. (Confirm with Assessors Office) CZ:I oo c., Legal Description_ Project Description & LA.,1 A ; -, y , Directions to site (Please attach map) -� �� ;��1 �i"� �� Cam- 45 ✓ y l r ti fi io;sf" Z; to Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc. t � 2 Answer the following to the best of your knowledge. County-wide maps showing general locations of critical areas ornci.i and resource lands are available for review at Mason County Department of Community Development, Planning U..only 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? r ❑ ❑ 2. Rivers, streams, or creeks with year-round flow? ❑ ❑ 3. Rivers, streams or creeks with intermittent flow but are within a clearly defined channel? ❑ [R❑ Lakes or ponds less than 20 acres in size? ❑ Y 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 or 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 fop wing programs: County Yes No ❑ ❑ / 1. Agricultural Open Space Taxation Program, RCW 84.33 ❑ ❑ [�J 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. KtbUUH(;I: LANDS & CRITICAL AREAS ' SITE PLAN r,LEASE 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,drainfields, wells & driveways. ► Project description Scale 1"= North Arrow W � Sol- ) S •' � °1 SP'eP a v, M I state that I have answered the above truthfully to the best of my knowledge. Applicant/Owner Date FOR OFFICIAL USE ONLY Adjacent property. I lair�cd CrUgtl y Rr3so0roe Land Maps, this property Is designated as ' 9. )Garr ternCommercial Forest _4, Shoreline Master ptdgram : < " .. lobo :. ?>< IdRn� Land 5, Ones not aPpIY fner M at Resour e La ntf . .....;:::.......... .. dE 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.