20171228 Ver 1_Shoreline Stabilization_20170927

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28
FXAMPLF AGENT AUTHORir.HTiON r"ORMI
pro rty Leeai Des,- ::t: s.
Parte; iD:
nt No. (if anoiicabie; _. pian NO, iif appiicaivdej
Street AOGie55 (itcrtNieias:ec
P, oerty :Jv ner:
Owner Name llnrir t's: Ha Y �, rU
13rnnerty Owner's Ad6res5i !R different than trig above!:
C
Owner Signature;AL.
The ahnwa retictereo nrooemv Owners of the 8a0ve property, rfa riereby cutriof rze
Agent Comaanv rjame iif aoolic$biei
to art nn mor hpha + anti -gke aii actions necessary for the aouilcation, wocessing, issuance ant
acceptance of to C: t � r Z^+' i tt st
u ce: '•.i:'vv<r:� r., : ?..:`f.4'!`J• .'.•'3C: S'p18.ri2i co%',"',-'.:tCt?':s
at t act ere
*,prehv certifv that iht < bove :nz ormation submitter on this form and appica;i:;r; is Lruf. ori(! aCCv.'o CE
�i1 t�lt :lC'Sl i+t !ti`s
Authorize(! ?gent
D
SEP 2 7 2017

Version 12/22/2016
Office Use Only: Form version Dec. 2016
USACE Action ID No. DAIR No.
r - ------ - .- ...-. y r....., .. — -a F Jab Pickm enter [vol Applicable" or -N/A-.)
I. Applicant Information
1. Owner/Applicant Information
Mailing Address:
Telephone Number: _� g j �Fax Number:�A
E-mail Address: nb
2. Agent/Consultant information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signry authority for the owner/applicant.)
3. Name: C at
Company Affitiation:
Mailing Address: p p R i a
a cmpnonc raumiDer: �s z �-�� 66.3;1 Fax Number: 2A
E-mail Address: ;bn „ Ir Z z 5r &2 --�
II. Project Information
Attach a vicinity map clearly 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 boundaries, 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. flan drawings, or other maps may be included at the
applicants discretion, so long as the property is clearly defined. For administrative and distribution purposes,
the USACE requires information to be submitted on sheets no larger than I 1 by 17 -inch format; however,
DWR may accept paperwork of any size. DWR prefers full-size construction drawings rattier than a
sequential sheet version of the full-size plans. If full-size plans are reduced to a small scab 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: hon k -Z ; Al Nearest Town: B c; -,"-KSubdivision name(includephase/lotnumber):. La k4 byq_J> L /3 cl 7_
Site coordinates:
Decimal Degrees (6 digits minimum): ON 1I 4 °W(neg.) -2Z
Directions to site (include road numbers/names, landmarks, etc.).
't i�rkf Yh
civ Tim
r « JarA210 w l e i 4,0..1q-,24 I.,l
aM f�gitlt
Page 2 of 4

3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of
some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: ,FJ -JJ k4,, Nearest 'town: _ IR Ljv17,,
Lake/ river/ ocean adjacent to property: -a k o A c y Cr I
Property size (acres): ` 4 ff c d - sti S&4 ;
Subdivision name or site address (include phase/lot number):
Directions to site -please include road names and numbers, landmarks, etc.:
7/-iri,..' Ti IZ._ '1 A }`t l Ally TL T[ i L 7� C S4G�7iG. •' �j/,
Latitude (in decimal degrees) ^,4Longitude (decimal degrees)a /k
5. Describe the existing land use or condition of the site �t the time of this application
(residential, undeveloped, etc.): , „ (a�,, L � , n/
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Ti , 5 tL JErAl 9. /rte
7. Will work be conducted from land? [D•- From water? n
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.
Li s f�.
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, construction 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):
11. Signature//,'."'
Owne..ent'sSignature'i5� �`C�aC ;2H .05QZ t
— ---_t _ 1� Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: S5GP 02-2017
Page 2 of 4

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
La ke
{At Ful l Pond/ Normal Water Level)
Full Pond Normal Water Level 0'r-t11*fAv
Plan
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Plan View
FORM: SSGP 02-2017
Page 3 of 4

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Version 12/22/2016
Lake
{At Full Pond/ Normal water Level) /
Full (Pond/
Normal Water Level
Slhorellme jg `� I�F90 � wc(t-P,c
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Plan View
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Cross Section View
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft)*:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors