HomeMy WebLinkAboutRLC Application - 1/10/1994 Date Received: NW
MASON COUNTY VT/ 6 o4
DEPARTMENT OF COMMUNITY DEVELOPMENT
ALIgq Ow14 RESOURCE
C LANDS AND CRITICAL AREAS CHECKLIST .3 7�S
The following checklist is designed to assist an applicant for a Building Permit, On- age 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 (77-93)*. 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 DAN IDA-r Vu Phone l#(206) 3G5- 9022
Site Address 1100 PtIC9 No.5HORE RD. Nur0olo m3► _City SEL..F'A)q Zip 28526
Owner Address 150 3 2 37 Ty N•E. City SLATI"r--E State\A Zip -C)S 15 s
Tax Parcel No. -3 22 Z1 - -_ 0 - 00032 Legal Description TrzAC T5 1% AND,")F'Lus N E SLY 10.00 Fr, oFTQgcrsO 1�u5 SW'Ly 8,46 Fr, nF Ti�CT- 9-7, cfr CAay'5
SUN 815E SEACN 7TQ/%rC7-5 ; 'SECTION 23,TowNS*t1P 22 No, RANGE 3\V.'W-M.
Directions to site (Please attach map) I I M I L-FES VE57- FROM 13E.LFA I R ON Noexn 5HOW
FROA0. U NDEV E40PED LOT LOCATED 113r—rwaEN Ex I ST"I NG Re_51tDEW41Z,5
^T 11031 AND 11041 No, SHooz.�.RED,
Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc.
4 Tr -C f4 CD 0R15rw 1 N G
1
Answer the following to the best of your knowledge. County-wide maps showing general locations of critical areas
officl.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 property?
County yea No
❑ ❑ 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 circumstances
support vegetation adapted for life in such conditions; such as marshes, bogs, and swamps. (See County
Maps for guidance.)
❑ ❑ 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.)
❑ ❑ f 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 yes No
❑ 1. Agricultural Open Space Taxation Program, RCW 84.33
❑ ❑ 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.
-ffhS6JHL;I=-LAND &-GRIT AREA-9--
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
S EE A-rr ACHED D RAW I N0— ^ND MARCH 1993 Sur{%/F-Y.
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I stat at I have swered above truthfully to the best of my knowledge.
Applicant/Owner "1 Mhuazy 120- Date
FOR OFFICIAL USE ONLY
Adjacent property.
... Us-in Counter ResQu�rce Land>Maps, this property Is designated a
T.' Long Terrrt Commercial Forest Land3 Mineral Resplrce land.
2 InhnldIn91and s n:or apply
.. .
�C. . ..... �'a LIZ
There is a $40.00 pplication fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Mason
County Treasurer.
When completed, this form bocomes part of the permit application.