20131155 Ver 1_More Info Received_20131121

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1. Location
County: , �) Nearest Town: _ �.1��;� �, �_, Ile
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Subdivision name or site address (include phase /lot number):d?� ?C.4:/4'�3 �11;17 ,T i
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): Clam T 7% `-i lee,
I Describe the existing land use or condition of the site at the time of this application:
I Property size (acres):
4„ Nearest body of water (stream/river /sound/ocean/lake):
5, Describe the purpose of the proposed work: —a, 16g "'
6. List the type of equipment to be used to construct the project:
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: l
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal pool lake level and 50 feet land -ward in square feet or acres:
.................. ........ ................
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8.b. Please
describe
�,ve� the r�or.�itt�l
vegetation I/j
S
p ica gent's Signature
( ent' gnature is valid only if an authorization let
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