20140488 Ver 1_More Info Received_20140519

1. Location
County: l Nearest Town:
Subdivision name or site address (include phase/lot number): ,
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): - -
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres):
4. Nearest body of watf J t A
l�
5. Describe the purpose `
6. List the type of equip
7. Amount of impact (ii ing walls, etc.) below the
normal ool lake levy L f
p
8.-a. Amount of impact (h r°� � dc- f-c�l rap, retaining walls, etc.)
above the normal poet or acres:
8.b. Please describe vegei feet landward to be impacted
(number of trees for
Applicant/Agent's Signature e✓ Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.),