HomeMy WebLinkAboutRLC94-00643 - RLC Inspections - 4/1/1994 Date Received: y _
Iq�= MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST
The fol%wing_� ist is designed to assist an applicant for a Building Permit, On-Site Sewage System Site
Evaluation a 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. r1 � . `*�
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Owner Y L ��.� �' S'i°i� .�f� ��/ tid L ( AQ Phone #( .W) P ---yv.r Y
Site Address City Zip
Owner Address D r />it cP City_ S'�.a b a".c h State -*-*�yZip f f-�'W
Tax Parcel No. (Confirm with Assessors Office) Z- .3 ,0, w Legal Description_
Project Description ,C'�,rr O ll GoT /
Directions to site (Please attach map) /Sri 1 -L12 C S f [�� �rar- �'� �i Ve c,,o/,/,odfQ --
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Please provide or attach a vicinity map which 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
ornci.i and resource lands are available for review at Mason County Department of Community Development, Planning
U.s only Department.
Do any of the following exist on this property or within 200 feet of this property?
Count Ye. No a�
❑ [� 1. Saltwater shoreline or a lake 20 acres or larger?
❑ ['r 2. Rivers, streams, or creeks with year-round flow?
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El ❑ 3. Rivers, streams or creeks with intermittent flow" are within a clear 'Ifined cha nel?
El � 4. Lakes or ponds less than 20 acres in size? tl
❑ a 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstances
support vegetation adapted for life in such conditior)s; su as marshes, bogs, and swamps. (See County
/ Maps for guidance.) /kb '' f
❑ ❑ [ 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.) ) —
C] ❑ 2 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.)
❑ ❑ Lid 8. Seismic Hazard Areas? (Sep County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.) i U
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 No
Q ❑ [� 1. Agricultural Open Space Taxation Program, RCW 84.33
❑ [R**� 2. Open Space Timber Taxation Program, RCW 84.33, or Designated Forest or Classified Forest,
RCW 84.34
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• 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).
P. Locate all existing &proposed structures,drainfields, wells &driveways. ► Project description
Scale 1"= North Arrow
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state that I bave answered e above truthfully to the best of my knowledge.
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Applicant/Owner Date
FOR OFFICIAL USE ONLY
Adjacent property.
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Using CoUllty Rsso"rQe Land N1ap , this Pfo' 'ot Y Is c es3gr ated as:
"I Long-term Commercial rrarest 4, Shrsrellrie Matter Program
.,,...... j.....,.. 2 Irttiolding Land m..n..,�._ . Goes not apply,
M[nerp. Resource Lard
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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.
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