20240326 Ver 1_More Info Received_20240416 (2)

5. Describe the existing land use or condition of the site at the time of this application (residential,
undeveloped, etc.): LSI p
6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary): u w' ' X 2, X �r A sh
7. Will work be conducted from land? ® From water? W
S. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, b ill, rip rap, retaini walls, etc.) in square feet:
b�FZ
Temporary impacts in square feet:
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet land-
ward
Permanent impacts (including back fill, excavation rip rap, retaining walls, etc.) in square feet:
Temporary impacts (temporary clearing, constrict on corridor) in square feet:
10. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50 feet
landward to be impacted (number of trees, for instance): a n NL
11. Signature
By signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate,
and complete to the best of my knowledge and belief
The project proponent hereby requests that the certifying authority review and take action on
this CWA 401 certification request within th applicable reasonable period of time
owner/Agent's Signs ] Date
'Agent's signs e is yaWiAly if an authorization letter from the owner is provided.
12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
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