HomeMy WebLinkAboutRLC98-00197 - RLC Inspections - 8/5/1995 MASON COUNTY
RESOURCE LANDS & CRITICAL AREAS CHECKLIST
PLEASE PRINT $44.00 Fee Re wired
Applicant: a Sc Parcel No.
Applicant Address: Z �`
City: ke-it St t�6 Zip � c c Legal Description:
Phone: 3 Si&q
Owner Name (if different from applicant:
Purpose of Pre-Inspection:
P+E • r S
Use of Building:
Do any of the following exist on or within 200 feet of the property: saltwater lake
river/stream _ pond wetland seasonal runoff slope
Dire tions to Site: ��'
Please illustrate in the box below the l4roposed building site in relation t property lines, 4�Q S Sic(Q
significant natural features, slope grade and direction and topography (or include on separat60f ed.
sheet):
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North Arrow t�G
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This 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 affect by regulations under the Mason
County Interim 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.
If the information is incomplete, then Mason County must disclaim any errors resulting from deficiencies in the original
application. Pre-inspection reports remain valid only until development changes occur in the vicinity which affects the
lot evaluated in this inspection.
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Applicant Signature: Date:
Return application to: Department of Community Development,Planning Division
411 N. 5th/P.O. Box 578
Shelton, WA 98584
(360) 427-9870/
Please make checks or money orders payable to Mason County Treasurer
When completed, this form becomes part of the permit application.
Please illustrate below the proposed buiLq*np site in relation to critical area & property lines:
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Departmental Review
(For Office Use Only)
Planning Department Findings:
7
RESOURCE LANDS & CRITICAL AREAS CHECKLIST
Permit Number f ' v RLC# 9 k-0197
Owner °' ' "1` Parcel NumberT23 d (7
❑ 1 . `Saltwater/Lake 20 z acres Designation
Name of Waterbody
❑ 2. .' ' Rivers, streams, or creeks
Type of Water
❑ 3. Lakes or ponds less than 20 acres in size
❑ 4. ,Wetlands: Areas that are inundated or saturated by surface water that
under normal circumstances support vegetation adapted for life in such
conditions as the following: Marshes, bogs, and swamps.
❑ 5. t Slopes greater than 15% or 8.5° If so,
,what
percentage
6. VI-11 dplain
❑ 7. ,,) Seismic Hazard Area
❑ 8. (Aquifer Recharge Area ton
❑ 9. ;Landslide Hazard Area
10. Comprehensive Plan Designation &Olt
Comments:
Authorized Signature Date
DRAWINGS & ADDITIONAL FINDINGS: