HomeMy WebLinkAboutRLC94-00154 - RLC Inspections - 1/28/1994 Date Received:—) �A/I i
1 *� MASON COUNTY —T—
DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE' " '� RCE LANDS AND CRITICAL
V AREAS CHECKLISTa
The following checklist is designed to assist an applicant for a Building Permit, On-Site Sewage System Sitel
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 earlyin the permit process whether there willbe any environmental regulations affecting
the proposed development.
Owner L '
Phone #(2(
Site Address
City Zip
Owner Address y City State Zip
�i
Tax Parcel No. (Confirm with Assessors Office)_ Zd 3c� - 7 it __ DUD S�
Legal Description_
23 o , 7 6 - --- �i00 5 I
Project Description_/ee�s �.oE.uGE
Directions to site (Please attach map) '
Please provide or attac a vic pity map which includes cross stree
major roads, creeks, etc.
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 only Department.
Do any of the following exist on this property or within 200 feet of this property?
County yea No
Y 0 4 1. Saltwater shoreline or a lake 20 acres or larger?
❑ J� 2. Rivers, streams, or creeks with year-round flow?
® ❑ 3. Rivers, streamscreely with intermittent low Ih�u are ithin a clearly defineld channel?M-* -,,�E-- u el 11 r3 rrtG�i 1 C �+r l?�.
dc`y
(� ❑ [4 4. Lakes or ponds less than 20 acres in size?
G�
4 ❑ [ 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.) kl-(1
❑ [ 6. Slopes greaterthan 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.l?J
(� ❑ RO 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.)
❑ ® 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.) 44-0
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
�L ❑ 1. Agricultural Open Space Taxation Program, RCW 84.33
4 ❑ [)� 2. Open Space Timber Taxation Program, RCW 84.33, or Designated Forest or Classified Forest,
I RCW 84.34
v
• Copies are available at Mason County Department of Community Development for $5.00 each.
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C SITE PLAN 11
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
P. 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
I state that I have answered the above truthfully to the best of my knowledge.
Applicant/Owner
Date
FOR OFFICIAL USE ONLY
Adjacent property.
llsin Cd'eartt R sc ur e lDd
11 Y e o I Maps this property is deig}rtafe4i as,
4, Long-tern, Cornmerciat f . rt)st Shrar�linf� �at��r Pro gran
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.3. Mfner7E Resourcf: Land :::>::. .,:•:;;
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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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