20120581 Ver 1_Application_20120612

Office Use Only
USACE Action ID No
DWQ No
20120581
Form Vcrsion Aucust 1006
(If any particular item is not applicable to this project please enter Not Applicable or N/A )
Applicant Information
Owner /Applicant Information
Name _ )A-VI a f VIGAO Iyl ZE4
Mailing Address I L/aS Pr rr,, m or-
Telephone Number 11, 1
E mail Address Al 17-
C
Fax Number
2 Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner /applicant )
Name
Company Affiliation
Mailing Address _
Telephone Number
L mail Address
II Protect Information
Fax Number
Nw7Ltt
IR
Q
Attach a vicinity map clearly showing the location of the property with respect to local landmarks such
as towns rivers and roads Also pro,, ide a detailed site plan showing property boundaries and
development plans in relation to surrounding properties Both the vicinity map and site plan must
include a scale and north arrow The specific footprints of all buildings imperious surfaces or other
facilities must be included If possible the maps and plans should include the appropriate USGS
Topographic Quad Map and NRCS Soil Survey with the property boundaries outlined Plan drawings
or other maps may be included at the applicants discretion so long as the property is clearly defined
For admimstratn a and distribution purposes the USACF requires information to be submitted on sheets
no larger than 11 by 17 inch format howe%er DWQ may accept paperwork of any size DWQ prefLrs
full size construction drawings rather than a sequential sheet version of the full size plans If full size
plans are reduced to a small scale such that the final -,ersion is illegible the -applicant will be infornied
that the project has been placed on hold until decipherable maps are provided
Location RR
County �� R til':1.1 ri Nearest Town iJ Ll Aid
Subdivision name (include phase /lot number) L-PrKE Rov fVL-E
Site coordinates
Decimal Degrees (6 digits muumum) °N 35 9 5$ 5,% W 7 9 19aM g
Directions to site (include road numbers /names landmarks etc ) _
Pr ecY ft "55 x„55 Page 2 of 4
64) �AbFtmort TiQ
l�ou�bar9, ntC a-154

r � 4� � 4 s i

3 Property size (acres) & 6 Rene.
4 Name of nearest named receiving body of water(stream/nver /lake) Lpl K Ray j�
5 Describe the purpose of the proposed work 1 PR 'P + sec
+rrA p, bal k k-m-4 vA rcyt 8J s hoc± I r
6 List the type of equipment to be used to construct the project 5/Af}11 ('kGPryP& —
�F bGRt orS►n►ul�� +a mraye rip-rap
7 Type and amount of impact (including all back fill excavation riprap retaimmnl, walls oilier fill
etc ) below the normal pool lake level in square feet or acres and distance from shoreline
me o - ' 4�aA s6rthn f
l it av at nc h �4si-` I s+ hdkiyefA, G wleAd rc /40,04
br6,t -tq b,a,WNA4 PO4 rrpraP >r0rmft*W\� 5-t r,) ufrWwP
8 a Type and amount of impact (including all clearing back fill excavation riprap rttarnmg malls
other fill gtc ) above the normal pool lake level and 50 feet la d ward in square feet or acres
Its be I 3 bro ,xi- (eve a 01
f S r
b Please describe the vegetation above the normal pool 14ke level and 50 feet land ward to be
impacted (number of trees for instance) &)o 'rA jAcF S Doi6 t>r,> rm CAr(�SS
'� ?� i 06 ) o ao
.a:�If P 4, / LAV� Applicant/Agent s aignature Date
(Agent s signature is valid only if an authorization letter from the applicant is provided )
Page 3 of 4

Full Pont!
Shoreline
Lake (Full pond)
15505-f n
OoLK
E
nl +5
VV
R-
G mi- o v5 h % \ 6WAM +G--ass 5¢t0 S-tffo
I �
Ai OF RtpR�'P
l00+1 AwAy
Please approximately sketch the following information on this plan
(Please provide dimensions for each item such as 10 It x 100 ft)
1) All proposed vegetation clearing (provide dimensions)
2) Location of rip rap or rill to he placed above the Full Pond elevation
3) Location of rip rap or fill to be placed below the Full Ponca elevation
4) The location of any proposed structures such as buildings retaining
walls docks etc
S) The location of any excavation or dredging belo +v the Full Pond
elevation
6) Location of construction access corridors
iae v«w