HomeMy WebLinkAboutRLC94-0644 - RLC Inspections - 4/1/1994 4 MASON COUNTY Date Received: /q 4 Ole �EPARTMENT OF COMMUNITY DEVELOPMENT 'fe. o D
14 77 RESOURCE LANDS AND CRITICAL AREAS CHECKLI �Lr �xcQS4��k
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The following.61
� list is designed to assist an applicant for a Building Permit, On-Site Sewage System Site
Evaluation and posal 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 willbe any environmental regulations affecting
the proposed development.
Owner P�1e 0. � Phone #s� b61 a 2�`3/9
Site Address L�zk� City = ' r- Zip gS ar 8,
Owner Address Q0 �T N-3 City r Statei—i-Azip
Tax Parcel No. (Confirm with Assessors Office)_ 5 jn - Legal Description
L 3J� �o �c lore a e s / -/3 —
Project Description
Directions to site (Please attach map) F t _ a
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Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc.
Answer the following to the best of your knowledge. County-wide maps showing general locations of critical areas
otnoi.i and resource lands are available for review at Mason County Department of Community Development, Planning
U.e o�iy Department.
Do any of the following exist on this property or within 200 feet of this ? - �~
property County Ye. No .. {„rt;
❑ 1. Saltwater shoreline or a lake 20 acres or larger? fP v
ElIJ 2. Rivers, streams, or creeks with year-round flow? U v
❑ [ 3. Rivers, streams or creeks with intermittent flow but are with* U a clearly defined channel?
�jEl Ed 4. Lakes or ponds less than 20 acres in size? ? i
0' ❑ 0 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 M
guidance.) � — (.t 6�z, ��c� Maps for
❑ E 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.) N
-1 ❑ ❑ 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.) t.
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
County Ye. No
(� ❑ 1. Agricultural Open Space Taxation Program, RCW 84.33
d ❑I?� 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.
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.
Applicant/Owner 3� Date
FOR OFFICIAL USE ONLY
Adjacent property.
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tlr CgUtlty Resource antl 1111as, thds'r�rol�t�rty Is eles(gntds:
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' 1, oracf.t rft; omrnercial I"ore,-A 4, Shoreline Master Progrartt
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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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