HomeMy WebLinkAboutRLC93-00522 - RLC Inspections - 12/17/1993 2'7
MASON COUNTY Date Received:
DEPARTMENT OF COMMUNITY DEVELOPMENT
RESOURCE LANDS AND CRITICAL AREAS CHECKLIST
The fPflowi\ng 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, Hazardous Waste Permit, or Shoreline
Permit in determining whether their property is affected by regulations under the Mason County Interim Resource
Ordinance (77-931*. 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 - �.`K. , �..�.;��. Q V.E. Gov. �1� 1(c,l�sk Phone
Site Address QJ , � \ (��,,,-� �� City Zip ` �r _�a s
Owner Address 34y�l Xv..�� �,, L,�_ City li",A C-N. i, Stateer9:o�,Zip `�'k3 46
Tax Parcel lNo.""' 2-2-6 10 D y S,1 Legal Description
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Directions to site (Please attach map) `yak y , �� � � V-), -"
Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc.
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n _DL 5u rv�.cr. I D/103 (C5 L 111 Z-)
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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?
coTpty Yes No
% ❑ (f� 1. Saltwater shoreline or a lake 20 acres or larger? h't
❑ 2. Rivers, streams, or creeks with year-round flow? 1AA
❑ [� 3. Rivers, streams or creeks with intermittent flow but are wit in a clearly defined channel?
❑ LB 4. Lakes or ponds less than 20 acres in size? I(II-A)
L/J ❑ LJ 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.) G ,j �-
El'
❑ Lid' 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.)
❑ L� 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.)
j ❑ E9Z 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 Yea 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
COpiAS are available at Mason County Department of Community !ievelopment for t5.00 ench.
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.
Scale 1"= North Arrow
I state tha a ans ered t above tru to the best of my knowledge.
Applicant/Owner / ^ / Date
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 Mason
County Treasurer.
When completed, this form becomes part of the permit application.
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PARCEL NO: ;Z2 3io-7 7-vog2c TE UPPR() /2
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- A SHORT PLAT OF A PORTION OF
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SCALE: 1"=100'
l **BEARINGS AND DIMENSIONS ARE T KEN FROM
SURVEY RECORDED IN VOLUME 10 OF SI;RVEYS, .
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WARNING: MASON COUNTY HAS NO RESPONSIBILITY TO BUILD, IMPROVE, MAINTAIN, OR '
OTHERWISESERVICE THE ROADS CONTAINED WITHIN OR PROVIDING SERVICE TO THE
PROPERTY DESCRIBED HEREIN.