20080737 All Versions_Other Agency Comments_20080424

APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT I OMB APPROVAL NO 0710-003
(33 CFR 325) Expires December 31, 2004
Public reporting burden for this collection of information is estimated to average 10 hours per response, although the majority of applications should
require 5 hours or less This includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of Information Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Service Directorate of Information
Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget,
Paperwork Reduction Project (0710-0003), Washington, DC 20503 Respondents should be aware that notwithstanding any other provision of law, no
person shall be subject to any penalty for failing to comply with a collection of information if it does not display a durrently valid OMB control number
Please DO NOT RETURN your form to either of those addresses Completed applications must be submitted to the District Engineer having jurisdiction
over the location of the proposed activity
PRIVACY ACT STATEMENT
Authority Rivers and Harbors Act, Section 10, 33 USC 403 Clean Water Act, Section 404, 33 USC 1344, Marine Protection, Research and Sanctuaries
Act, 33 USC 1413, Section 103 Principal Purpose Information provided on this form will be used in evaluating the application for a permit Routine
Uses This information may be shared with the Department of Justice and other federal, state, and local government agencies Submission of
requested information is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit be issued
One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this
application (see sample drawings and instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed
activity An application that is not completed in full will be returned
ITEMS 1 THRU 4 TO BE /LLED BY THE CORPS
1 APPLICATION NO 2 FIELD OFFICE CODE 3 DATE RECEIVED 4 DATE APPLICATION COMPLETED
ITEMS BELOW TO BE F LLED BYAPPLICAN
5 APPLICANTS NAME 8 AUTHORIZED AGENT'S NAME AND TITLE (an agent is not required)
North Carolina Department of Transportation
Project Development & Environmental Analysis
6 APPLICANT'S ADDRESS 9 AGENTS ADDRESS
1598 Mail Service Center
Raleigh, NC 27699-1598
7 APPLICANT'S PHONE NOS W/AREA CODE 10 AGENT'S PHONE NOS W/AREA CODE
a Residence a Residence
b Business 919-715-7844 b Business
11 STATEMENT OF AUTHORIZATION
I hereby authorize, to act in my behalf as my agent in the processing of this application and to furnish, upon request, supplemental information in support
of this permit application
APPLICANT'S SIGNATURE DATE
NAME, LOCATION, AND DESCRIPTION OR PROJECT OR ACTIVITY
12 PROJECT NAME OR TITLE (see instructions
Fayetteville Outer Loop (X-0002 B & C, U-2519 AA, AB, BA, BB, CA, CB, DA, & E)
13 NAME OF WATERBODY, IF KNOWN (if applicable) 14 PROJECT STREET ADDRESS (if applicable)
Cold Camp Creek, Horsepen Branch, Long Branch, Buckhorn Swamp, Carvers Creek,
Mcpherson Creek, Cross Creek, Little Cross Creek, Stewart's Creek #1 & #2, Rockfish Creek,
Little Rockfish Creek, Beaver Creek, Persimmon Creek, Bones Creek, Big Branch
15 LOCATION OF PROJECT
Cumberland, Hoke, Robeson NC
COUNTY STATE
16 OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions) Section, Township, Range, Lat/I_on, and/or Accessors s Parcel Number, for example
Fayetteville, NC
17 DIRECTIONS TO THE SITE
Please see attached vicinity map and cover letter
ENG FORM 4345, Jul 97 EDITION OF FEB 94 IS OBSOLETE (Proponent CECW-OR)
18 Nature of Activity (Description of project include all features)
construct a new multi.-lane freeway around a portion of the City of Fayetteville
19 Project Purpose (Describe the reason or purpose of the project see instructions)
Provide an additional transportation corridor on the south, west, and north sides of
Fayetteville, extending from I-95 south of Fayetteville to dust west of Ramsey Street (US 401)
north of Fayetteville and complete a circumferential transportation facility around the city.
USE BLOCKS 20-22 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED
20 Reason(s) for Discharge
Construction of a new roadway that crosses several jurisdictional waters of the US
21 Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards
Please see attached permit drawings for site-specific details
22 Surface Area in Acres of Wetlands or Other Waters Filled (see instructions)
Please see attached permit drawing summary sheet
23 Is Any Portion of the Work Already Complete? Yes _ No X IF YES, DESCRIBE THE COMPLETED WORK
24 Addresses of Adjoining Property Owners, Lessees, Etc , Whose Property Adjoins the Waterbody (If more than can be entered here please attach a supplemental list)
Please see Permit Drawings
25 List of Other Certifications or Approvals/Denials Received from other Federal, State, or Local Agencies for Work Described in This Application
AGENCY TYPE APPROVAL IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED
N/A
Would include but is not restricted to zoning, building, and flood plain permits
26 Application is hereby made fora permit or permits to authorize the work described in this application I certify that the information in this application is
complete and accurate I further certify that I possess the authority to undertake the work described herein or am acting as the duly authorized agent
of the 7. 10
SIGNATURE OF APPLICANT DATE SIGNATURE OF AGENT DATE
The application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly authorized
agent if the statement in block 11 has been filled out and signed
18 U S C Section 1001 provides that Whoever, in any manner within the junsdiction of any department or agency of the United States knowingly
and willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious or fraudulent statements or
representations or makes or uses any false writing or document knowing same to contain any false, fictitious or fraudulent statements or entry, shall
be fined not more than $10,000 or imprisoned not more than five years or both
ENG FORM 4345 Jul 97 EDITION OF FEB 94 IS OBSOLETE (Proponent CECW-OR)