20240340 Ver 1_More Info Received_20240418 (3)

S. Describe the existing land use or condition of the site at the time of this application (residential,
undeveloped, etc.):
6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
7. Will work be conducted from land? 0 From water? 1�9
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
A 2,0'
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,ppnstruction corridor) in square feet:
LA'
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):
nIQ `f� .4ez.r
11. Signature
By signing below,1, 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 6WA 401 certification requestywitliethe applicable reasonable period of time
I---- ?/
5ature° 115ANC—A-CO211.M02Date
is valid only 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 wails, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
i aii:iE02r_, of %aLS mtlls: i&
3.11 Ncrt3 biWdubu SLeaE WA, eiatE 4+�of>a: V: vn�r S [B.^,�cs�:.. icauf37, G::ecvlins..'.7ts'3u:.4hC7'
s

ml
UT
Full Pnn,417
(At Pall POW®NUffibaal WazeyLovel)
i t, -T?—, 2WA4
1AkXAIVA*L Disrup.
Ta au Z
&4-4o
Please approximately sketch the following IU��r�l�r� Kin °�Ful tlr� �����?de d!
it", such as 10, ftx 100 ftj' menyjons, fcreach
. All proposed vegetation clearing
2. Location of rip rep or fill to be placed above the Fui9 �©U� °
3• Location of rlp rap or flit to be placed below tl�e ��ll P@n ®N O msl Water Level elevation
4. Location of any proposed structures such as buildings, P, retaining al Wetter Level elevation
5. Location of any excavation or dredging belaw °kh Full Pond/ Normal docks.. etc.
6. Location of construction Recagg corrid® Water Level elevation
FORM: SSGP 10-2019
page of a