HomeMy WebLinkAboutRLC94-0177 - RLC Inspections - 2/1/1994 J Date Received: Cl 1-1
MASON COUNTY
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F IM VELOPMENT
• RESOU D RI S CHECKLIST
The folloo. ing c ecklist is designan pp ica or a ilding 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 foridentifying earlyin the permit process whether there willbe any environmental regulations affecting
the proposed development.
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Own l t�c�ti..�.s lev�t reSC' Pho # lug 6 - ,) S
Site Address 011A IJG (!Sl Tesrtk.c t City Zip
Owner Address d(p9'.4 10 " AV Q_ /C� City Rn--Js b o State(JAZip 9 V3 7()
Tax Parcel No. (Confirm wyth Assessors Office) a a 3 I 1 - S (j v I -U Legal Description_
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Project Description Lc,v\A ov,e ���;�� �,� ,�,c f� r �Da"tc .reC kk V1C42
Directions to site (Please attach map) l c,,\,e� �� �e��c,�r ��w�, �j1r�.w. U�e,tc,tr1V�Ie
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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
Use only Department.
Do any of the following exist on this property or within 200 feet of this property?
Co t Ye. No �
❑ ® 1. Saltwater shoreline or a lake 20 acres or larger? �
❑ �J 2. Rivers, streams, or creeks with year-round flow?
X1 ❑ NJ 3. Rivers, streams or creeks with intermittent flow bu ate, within a clearly defined channel?
❑ [0 4. Lakes or ponds less than 20 acres in size? v
G] ❑ ] 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.) .v
❑ ® 6. Slopes greater an 15% 8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
r guidance.) �i � '�'`�1 �� � _V
[3 ❑ ® 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.)
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
County Ya No
❑ ® 1. Agricultural Open Space Taxation Program, RCW 84.33
E] ❑ ® 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 55.00 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 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. c/
Applicant/Owner ��` / Date
FOR OFFICIAL USE ONLY
Adjacent property.
Usin .panty Resource Land Maps. this property is deli hated as.
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....
1, Long-tern, Commarolat sorest _ -4, I Shoreline Master;Prog ram
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2 '�nholdin Land .....<::::::::::> >::......: a : Roes slut apply
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...Mineral Resource hand
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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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.�/�/ * r) �irj.•!%l •• .•1 (206)871-0171 RES.,478-4397 PAGER
L,) ' ';, f ,+('1/�'�� ••'h;r YJ, }JI 11J. I.p,• �• , A (206)682.5982 SEATTLE
1. : !� '.l•�II 4;+1 KIP SMITH
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�.!•• ..� PARK SHORE REAL ESTATE
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