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Home My WebLink About20110996 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 ��' �� `��' i� � w � ,��a/j//�ir/ri . <.�"`�� !!(� Y�� a � v� s � �� a � � /i�, ,�i�r% �r ,�u� Lake �Fult �anti) �� 6✓ j�----- ��r --�I �� t �o��°,�� nCFr��(i� .s� r�' �9�' � ��Q�,S ES`,L, ��,,o._..� (�`P f � �t f� __ -�—_� �� /i�u 7 � � — -- — �t� �� i � �----7.a —'�' �I U'._ � ��, S� �� i ��- � excye,� � C�'"� 'bo�-c�8 � ��,��, � I �� I � � � _ ___ �-r�J�jPi 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