HomeMy WebLinkAbout20110996 Ver 1_401 Application_20111114 20110996
Office Use Only Form Vers�on August�006
USACE Achon TD No DWQ No
(If any particular itein ts not appl�cable to this pro�ect please enter Not Applicable or N/A ) �
I Apphcant Tnformahon � LD� �' �
1 Owner/Applicant Information � �)NI,$}��! � ����QSS
Name �-h,�'�� 9��� �6�G� �
�
Mailmg Address��Uy C�,�1-���rvr' p2 �2,t�'t�� d1/� ,Lz
Telephone Number a1q ��t� �,��`� Fax Ntunber
E mail Address c�,kbGCaa� � c�'�c,� rCv+r
2 Agent/Consultant Information (A signed and dated copy of the Agent Authorizatzon letter must be
attached if the Agent has signatory authority for the ownerlapplicant)
Name �
Company Affiliatzon D
Mailmg Address
01�
Telephone Number Fax Number ��,R wALERaU��H
E mail Address yy�aNDSqNOSTORM'�'lA
YI Pro�ect Tnforznation
Attach a vicinity map cleazly showing the locat�on of the property wrth respect to ]ocal landm�rl.s such
as to�vns, ritiers and roac� Also provide a deta�led s�te plan showmg property boundartcs �zid
development plans m relation to surrounding properties Both tlie vicimty map and site plan nlust
mclude a scale and north arrow The specific footprmts of all buildmgs impervious surfaces or o�her
fac�lities must be included if possible the maps and plans should include the appropriate USGS
Topographtc Quad Map and NRCS Soil Survey with the property boundartes outlined PIan dra��mgs
or other maps may be mcluded at the applicant s discretion so long as the property is cicarly defined
For administrative and distnbution purposes the USACE requires info�ahon to be submittcd on sheets
no lazger than 11 by 17 inch format howe�er DWQ may accept paperwork of any size DWQ preC�rs
full size construction drawu�gs rather than a sequential sheet version of the full sizc pl�ns If full si7e
plans are reduced to a small scale such that the final version is illegzble the appIicant r�ill bc xnfornied
that the pro�ect has been placed on hold until decipherable maps �re protiided
1 Location
County ��A�nk-��,n� Nearest Town 13J�►U'
Subdivision name(include phase/lot number) �.,Vt-� �n1�2. _
Site coordinates
Decimal Degrees(6 dig s muuznum) °N >�� 5B `���� °W '►53g �.� lq ��
Directions to site(include road numbers/names landnnarks etc ) ���,,,�. �ti o�dv_h�
�r1�e. �„-�k-��f eS�,� c�..�-�t e.�-s i ta S 1.�-c�..�e 1�.,�.y (� �'
17 r�. �(�t��,t ��G'�' C� `�n 2x��r'ti� �f' �`p �4t'�i t�tv�a f� `�
L.��� �N s�,�T(�r�1���e c.���. ��o� Po ��A-e- t,��1 t t s�`f�
Page 2 of 4
3 Property size(acres) " ��
4 Name of nearest named recervmg body of�vater(stream/nver/lake) L�,�� �v y��C
5 Descrzbe the purpose of the proposed work ln•�;,a-u-rr-r,�� B� �P p �i7..� �-o�,�yc�-
��� .c� �E- �k�`�T� ,� bv L , ��n.S Rc�.. e , i P_���t"—fi—�'�
T..-__.�_____��.,.__._,�� ,��
r.�•s t.�►-C 1��^c..� a�'� � � tn t �
6 List the type of e uzpment to be used to construct the pro�ect S�t,a�'s t n� 1�-f�,�.2c��
�
7 Type and amount of �mpact (including all back fill excavation riprap retaimng walls other fill
etc)below the nonmal pool lake level in square feet or acres and distance froxn shoreline
�`� �f±P �t�rs7Ar�,aa��p,,. is �tii, ����������/7w�".►-�/ �c�s L% �7D�s� �
�t%T�k YR�.-Q � �'Je. �.r 1 t^�' G�2✓ �c Te 1✓( i ,I'� �L�/YT �/1G�� lO��3� �
�lt+r2� � �y(� C�� �/���
8 a Type and amount of impact(including all clearzng back fill excavation r�prap retaimng w alls
other fill etc) above the normal pool lake level and 50 feet land ward m square feet or acres
S�h K �s �-� h E�it.�d ,9-�-er V' P ��p ,`''�STr�il.rd -�i 1.1�� �,� ��� �-�.y�° ��fc s�:�v�-t�z � �3
������r�r ��d
b Please describe the vegetation above the normal pool lake level and SO feet land �vard to be
irxipacted (number of trees for instance) _ �,a�
� �l l Q/��
Applicant/Agent's Signature Date
(Agent s signature is valid only if an authonzation letter from the applicant is provided)
Page 3 of 4
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Please ap�rax�r��a#eCy �keteh tt��f�[fa��,v►n� �n�orsri�.tio� Qn tk�rs �lan
�(�L�ase pro�fic�e dimehsions�for ea�C� �tem, si��h as 't0 6t �c'�QU�t)
'f� �tl) prapt��ed �regeta�ian �]earin� �pravode r�imenseansy
2} �.��at�Qn of r�� ra�r �r Fill to be �I�c-e�! al���� th� �ul��ond ei�vat�on
�) Locatic�n �f rV� rap or FiJI ta f�e �I��,��i belov�tt�� �ull P��id eleu�t��r�
�� The locatwn o�any praposed struetures such as �Uddin�s retamin�
vr�:IGs docks etc
�} T��� Iflc���c�r� oF a�t}► e�cca.����4t� Ar dt'eclg�s�t� 1)e[o��v �he Full Po�d
el�v�tto��
6) Lacatia� of cons�ruction access �ornc�ors