Application - Site Plan - 3/29/2024 10:14:37 PM

5. Describe the existing land use or condition of the site at the time of this application (residential,
undeveloped, etc.): Q tl,)L­tJT,.Ad
6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):�ZPI-49 ��}tD : 'jam /=
7. Will work be conducted from land? M From water?
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:
O `
Temporary impacts in square feet:
NIA-
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:
�3 q SS'
Temporary impacts (temporary clearing, construction corridor) in square feet:
nc I&
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): 6N M
11. Signature
By signing below, I, as the project proponent, certify to the following:
a The project proponent hereby certifies that all information contained herein is true, accurate,
and complete to the best of my knowledge and belief
o The project proponent hereby requests that the certifying authority review and take action on
this CWA 401 certification request within the applicable reasonable period of time
3
O Signature' [1SANCACO2H _0-3021f 1 Date
'Agent'ys'ignatur—e-isAlid only if an authorization letter from the owner is provided.
12. Please approx-i <etch 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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