HomeMy WebLinkAboutRLC94-01054 - RLC Inspections - 5/11/1994 MASON COUNTY Date Received,It54
DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE LANDS AND CRITICAL AREAS CHE KLIST
The following checklist is designed to assist an applicant for a Building Permit, On-Site Sewage System S,
Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Line Adjustments, Lal
Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affected
regulations under the Mason County Interim Resource Ordinance (77-93)*. This checklist is an importa,
opportunity for identifying e_arlyin the permit process whether there will be any environmental regulations affectil
the proposed development.
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Owner �� .�E-�'T T,q-ers,�S Phone I# sib) S7//6"
Site Address City Zip
Owner Address__ >-5� 3 >=1�L, �� r¢�r� City, d( fate�i✓Lip�
Tax Parcel No. (Confirm with Assessors Office) 223c�
-����--- 0160 Legal Description_ '
Project Description ��� i2yj�
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 area
otftot.l 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 property7
county Yet No
❑ (2 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?
(� � ❑ 4. Lakes or ponds less than 20 acres in size?
❑ 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstance:
support vegetation adapted for life in such conditions; such as marshes, bogs, and swamps. (See Count\
Maps for guidance.) V J
❑ ❑ 6. Slopos greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps fo
guidance.)Lt — (2-%) 0 ' -/ -At
❑ [� 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard MaF
for guidance.) �,�✓J
l
❑ [� 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.) Gt�
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in an,,
of the following programs:
Co t Yes No
❑ 1�1 1. Agricultural Open Space Taxation Program, RCW 84.33
/(J ❑ PD 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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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. P. Location of significant natural features(water bodles, rivers),
(► LLe!ate all existing &proposed structures,drainfields, well* &driveways. P. Project description
►scale 1"= North Arrow
I state that I h ve answered the above truthfully to the best of my knowledge.
Applicant/Owner -���y 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 Masor,
County Treasurer.
When completed, this form becomes part of the permit application.
1 1
OWNER; R❑BERT JAC❑BS LIC. CONTRACTOR
1423 Flower Ave. Tire Mackie 871-4790
Port Orchard, wn, 98366 TRADEMARK BUILDERS
871-1000 Daytime
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Assessor's Parcel No, 223047690160 Short Plot No, 1634 Lot 6A