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Home My WebLink About20071545 Ver 1_401 Application_20070912~ 7" ~ 545 .Office Use Only: Form Version August 2006 USAGE Action ID No. DWQ No. (If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".) I. Applicant Information 1. Owner/Applicant Informatio Name: /1~ItG/`fF~ E ~o ~,•~ ~ y ~~,~~ c~ Mailing Address: 8y 2/ - / 03 /~L[_s/~t/S L ~•vQ,zivG Telephone Number: / - - 2 ~/ 3 Fax Number: E-mail Address: 2. AgendConsultant 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: E-mail Address: II Project Information ~; i _~ " laS f....u< ~ ~' 1....,.i~r 'ii ~~ a ~= ~ ~ "LOG l Attach a vicinity map cleazly showing the location of the property with respect to local landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property boundarics 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, impervious 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 appIicant's discretion, so long as the property is clearly defined. For administrative and distribution purposes, the USAGE requires information to be submitted on sheets no larger than 11 by 17-inch format; however, DWQ may accept paperwork of any size. DWQ prefers full-size construction drawings rather than a sequential sheet version of the full-sizc plans. If full-size plans are reduced to a small scale such that the final Version is illegible, the applicant will be informed that the project has been placed on hold until decipherable maps are provided. 1. Location / County:_ f/Qi4/~i~~ ~ Nearest To«-n: ~u N~ Subdivision name (include phase/lot number):_ L~9Ke~ d~~p~ Site coordinates: Decimal Degrees (6 digits minimum): °N °W Directions to site (include road numbers/names, landmarks, etc.): ~iQa M ~4 titi, __ ~'fS 7 0 ~/ ~,~P'lrs 7 ~,~u.~err ~D .. ~'1 ~rv~ ~'~ ~2 ~v ~2.r~, y Fax Number: Page 2 of 4 3. Property size (acres): D, Z 0 y ~A-c.ec~' /}idPkd,(% 6 ~ ~ X /Z~~ Lo 7' 4. Name of nearest named receiving body of water(stream/river/lake): Lf~~iL~ ~0~/'/4L ~ 5. Describe the purpose of thelproposed work: ~~~ ~/iQt`PL,EcE C~'~S7 ~- ~ZILK/~~ /~'y ~S ~GLCA~J F~ . L~'~,S7,ta.~ f3uLK//[SI#~O ~/4~CA' 3o yRf p L~ ~~.r7~" ~~ A? ~ ocK sic ~ S1~y gtiL/,W ~rc~ ~,/ 1i9•~-F LacA~a.~, 6. List the type of equipment to be used to construct the project: ~;~~0 7v LS oit/Gy ~t/y i~cs9dy /yi.~c~y ~~s- ~oFo 7. Type and amount of impact (including all back fill, excavation, riprap, retaining walls, other fill, etc.) below the normal pool lake level in square feet or acres, and distance from shoreline: w,TL L ,t/,r~/etc~'~ ~~~ ~ C Li/.X'i/,~/lJ /~i~R/J y 1 ~ aL Fly, i1...G- I~K~tta-.E/LA .¢? ~/c'zSd ~~ `yrC. ECtiS~i~uc 7.c.~a/. 8. a. Type and amount of impact (including all clearing, back fill, excavation, riprap, retaining walls, other fill, etc.) above the normal pool lake level and 50 feet land-ward in square feet or acres: ~NLy S ~ - ~v ~ v,~ i/rQccA t~~ .Vc`~cD 7 P3F /3~[~Fxcc ~ ~- 6rcirt KF/~C.A~v7c~,p /f1 ~ Co~~'~-7~-~ b. Please describe the vegetation above the normal pool lake level and 50 feet land-ward to be impacted (number of trees for instance): NO T~FES d2 ,~~„e4/~~y u,fec t ~~ -/~-/~C~. D~f/Lt/ f~'d17~'n.~" 6~Q.tl~! T.~,~1T ...t~~ r ~~..~..e~- Applicant/Agent's~Signature Date (Agent's signature is valid only if an authorization letter from the applicant is provided.) Page 3 of 4 Lake tAt Fuil Pand) Full Pond Shoreline G1!>N"!~ ~rli OR =ti0ft dac.k JU K x 1 ft ria raD ~ ft x ISD ft i Inrlnw' fol) ,~~-~<<- r R >< 16D K •iln~w: full I,.....1 EXAMPLE Please approximately sketch the following information on th;~. E>tan (please provide dimensions for each item, such as 10 ft, x 1 ~:: ~~ f t I; i) Afl proposed vegetation dearling !provide dimensions} 7) location of rip rap or fill to be placed above the Full Pon;; el~ v,~tian 3) Location of rip rap ar fill to be placed below the Full Pun~.l ~;Ir~ratiun 4) The location of any proposed structures such as ttuildinc,~.. retaining walls, docks. etc. 3) The location of any excavation or dredging below the Fut~ Pund elevation. 6) Location of construction access corridors. Lake Full panda Fall Pc~r~d Shoreline Please approximately sketch the fa[[owing iniortnatio6~ on this plan {please pro~ride dimensions for cacti item, :such as 10 ft. x'100 ft): 'f) All proposed vegetation clearing ~pravide dimensionsf .2j Location of rip rap or fill to he played above the full Pond elevation 3) Location of rip rap ~r fill to foe placed belovr the Full Pond elevation ~) The location of a.ny proposed structures such as buildings, retaining vralls, docks, etc: 5} The location of an}~ excavation or dredging be[o~v the Full Pand elevation. 6) Location of construction access corridors. ~a A T 2N,,,~ ~,Et~~ ~,M r~`'D. u ~ /~ u c.K /h~44 Rack H ~° W~ ~~ a~~ T ~q?oZNa~"~ '~toPN~7#~S 3~kSi