20141123 Ver 1_Application_20141023

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DIVISION OF :'U-- R 01JA!_ITY
OCT 2 2 2014
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E-,g0OREMLLE RF- r- 0iI'AL OFFICE

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The following is an abbreviated application form for those applying for ;r 101 Wahl l Qo,slit►
(l i titx;ltii,n to impact FERC (Federal Energy Regulatory Commission)) regulateif lake shore or
bottom under the U.S. Army Corps of Engineers permit GP30. This Application cannot be used
for wetland or stream impacts, l ?fc'' lrl
oil( tFii , i, }ii °Eitii ►ii ,,,,s Supporting
ilifi�i rilatir,n as art 11 "I" 'I nnii i efitll ►f.il ►li applic•alloll lee to-1 ilt• DTI. isioll of 14 Elter �trtllifl_ of �+Z.tti,t}t}
equal i,,,to t5 til l;ilu' huttul,i of IrSti tl,iis, t :i� ry and $570.00 for impacts to lake bottom of greater or
edual to l acre.
Applications should be sent to:
DiNisioll of 11,11ier Qllalil� -Fti! [)�srtii}; #ltlh:attrc55 K���'icif
hail's 1't�rnjitting'
rvive (:enter
lt�slt•it;h,_I�(' 27f►9+�- ifi.SU'
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2.
Applicant Information
Owner /Applicant Information
Name: k a v
Mailing Address: 5,14
Telephone Number: ]py - Q _ S �� Fax Number:
E -mail Address:�a
C o W-\
Agent Information (A signed and dated copy of the Agent Authorization letter must be attached
if the Agent has signatory authority for tile owner /applicant.)
Name: >
Company Affiliation:
Mailing Address:
Telephone Number: / -— ____..
E -mail Address: Fax Number:
II. Project Information
Attach a vicinity map clearly showing the location of tile property with respect to local landmarks Stich
as towns, rivers, and roads. Also provide a detailed site plan showing property boundaries and
development plans in relation to surrounding properties. You may use the diagram below to make n
hand sketch of your project. Also, see the example below for guidance. Both the vicinity map and site
plan Must include a scale and north arrow. e all buildings, impervious surfaces, or other
facilities must be included,
�II)I

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1. Location
County: I`Q W CA yti Nearest Town: Ste-
Subdivision name or site address (include phase /lot number): EC U !C_�_
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate T
vicinity map is included): Man , nG���,Q , _T7,<' kJ A1_ f - 1 ' _ I
COO J ONG, r\,
� a�1 R.4_ y M) le.
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): A, O C, Y r S
4. Nearest body of water (stream /river /sound /ocean /lake): y 2 Qe r
5. Describe the purpose of the proposed work: _ 40 P w. S I ­A -4 D; e i Q
n j ( A v��aJ� � � c� o.'f e✓
n,, iriT.,a 1 y 1^­ 11,, Q Ok1 S f (llq +e -Al J
G. List the type of equipment to be used to construct the project: ] C.2 c e
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: ot 1 ,I ld s 0
14 od
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:
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): p O_
'YM•'vwuvr�bp„l S glgnalu['(; -- v L O
(Agent's signature is valid only if an authorization letter from the Date
is provided.)

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