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HomeMy WebLinkAboutRLC94-01459 for BLD94-01338 and 01334 - RLC Inspections - 2/7/1995 MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT RESOURCE LANDS AND CRITICAL AREAS CHECKL ST �L7)u � c33`� 134q Permit Number— RLC# Owner (,��' a el( Parcel Number_ l �j 6 0 L� ❑ 1. Saltwater shoreline or lake 20 acres or larger? n .l Name of Water Body ❑ 2. Rivers, streams. or creeks with year round flow? f vU Type of Other Water 3. Rivers, steams or creek with intermittent flow but are within a clearly rdefined chap el? Ir aA-- N- ❑ 4. Lakes or ponds less than 20 acres in size? 1r m 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstances support vegetati n adapte for lif in such conditions; uch s marshes, bogs, and swamps. PM C( -&& lb6'r 6. Slopes greater than 15°h {8.5 de rees)? OW slide Oazard Map? 1/0 of Slopes ❑ 7. Floodplains? \\ / 3 3J ❑ 8. Seismic Hazard Areas? (�U ❑ 9. Agricultural Open Space Taxation Program. ❑ 10. Open Space Timber Taxation Program, or Designated forest ssified Forest? ❑ 11. Site has no Resource Lands or Critical Areas. - Comments: y'J�� G� �- V.Vu V-j�NO-�I Author17GC SITI7ture Date ' Date Received: MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT RESOURCE LANDS AND CRITICAL AREAS CHECKLIST The following 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, 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. Owner i fflonidQZ Z. on N Site Address W\ City An 1r- Zip Owner Address/l City I r- StatelW Zip ' Wcge Tax Parcel No. (Confirm with Assessors Office)dd3// - - 0002$0 Legal Description 8 — c��'��r 'f=�*'= , -Jv 1 '-I d Sslfx'�e�s �e�S _�9-d1,. c�r�r4aK .�la �= 3�1S S 7/ Project Description Directions to site (Please attach map) korm In n Please provide or attach/[a��vicinity map which includes cross streets, major roads, creeks, etc. (✓I do-h) PC$S lea+ V ti II � Camp 2d 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 u.e oNY Department. Do any of the following exist on this property or within 200 feet of this property? County Yes No ❑ ❑ El 1. Saltwater shoreline or a lake 20 acres or larger? ❑ ❑ 21 2. Rivers, streams, or creeks with year-round flow? ❑ ❑ 0 3. Rivers, streams or creeks with intermittent flow but are within a clearly defined channel? ❑ [D ❑ 4. Lakes or ponds less than 20 acres in size? ❑ ❑ El 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.) ❑ 9 ❑ 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for ❑ ❑ 7. Floodplains? (See County Federal Emergency Management Map- and Cot�n+,, Scis,;,ic Hazard Map for gulUallue.) ❑ ❑ A 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 Yes No ❑ ❑ 0 1. Agricultural Open Space Taxation Program, RCW 84.33 ❑ ❑ 0 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 $5.00 each. r K[_:iUUKC.t ��'-airti.� u► ITIlvAll AREAS SITE PLAN j �dQ_kd PLEASE SHOW THE FOLLOWING INFORMATION 04 PROVIDE SURVE MAP IF POSSIBLE: ► Location &dimensions of existing &proposed property boundaries. ► Approximate sloe of land (grade &direction ),n topography.g !, ► identify fagal access including,width of all road right-of-ways&easements. ►Y Location of significant natural features(water bodies, rivers). ► Locate all existing & proposed structures,dralnfields, wells &driveways. ► Project description Scale 1"= North Arrow I state that I have answered the above truthfully to the best of my knowledge. 1 ' �w �l Applicant/Owner Date FOR OFFICIAL USE ONLY Adjacent property. If1, sing County Re$(,uroa Ond Man+>;°��hix r;rnh�►,,. ,,. , , u.. y 4 2. Ir c Land yE�alciln . Mr sera€.�..�,... Resource `< ::<: �:> ::':>��>:>:::::>:::»:><:<:>:::: Land p to !' 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.