20180669 Ver 1_Shoreline Stabilization_20180515

Version 12/22/2016
201 80669
Office Use Only: Form Version Dec. 2016
USACE Action ID No. DWR No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or 'NI.
_ Applicant Information
A/
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U0 X11
1. Owner/Applicant Information Twig _ Mq 1. D
Name: H 018
Mailing A��d//d��rrless:,
T7! !��- l� � Ld U/SaG✓tj � Z7 S� /� AFF NF{ RMITr ES
Telephone Number: 245 90 34 Fax Number: -�—
E-mail Address: IeMg, t.65
2. Agent/Consultant information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
3. Name: —MAA Mb!S5,
Company Affiliation: tSTS TIL
Mailing Address: z3.<6O lqj- /f&!�F
SW�%27673
Telephone Number: Fax Number:
E-mail Address: a C A?i MAil- to M•
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. Plan drawings, or other maps may be included at the
applicant's 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 11 by 17 -inch format; however,
DWR may accept paperwork of any size. DWR prefers full-size construction drawings rather than a
sequential sheet version of the full-size plans. If full-size plans are reduced to a small scale 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: �Y�JhI/� Nearest Town:
Subdivision name (include phase/lot number):
Site coordinates:
Decimal Degrees (6 digits minimum): IN 55,1 160761 °W(neg.) "'763.1 !J8 7,0
Directions to site (include road numbers/names,n amarks, a c.):
�TIU / ! Tr CA" UA -7-25- Ai✓ � u�- G �c
# is SC' ow
Page 2 of 4

Version 12/22/2016
3. Property size (acres): -7z Aws
4. Name of nearest named receiving body of water(stream/river/lake): 1wZ A64,
5. Describe the purpose of the proposed wi
70 AOW. Go' Gjc� 1uA7U**-
6. List the type of equipment to be used to construct the project: 4 le/D 57&72 4
I&nu • e-YC4V 4-7-v2
7. Type and amount of impact (including all back fill, excavation, riprap, retaining walls, other fill,
etc.) below the normal pool lake level in square feet or acres, and distance from shoreline:
-7/ ,�3t ^l" off= ,ei� -i 0-ro. S ex, ry- SY&,*z G gd=
Ausc 571ZWcsl90G Z:1 5CCJX
8. a..Type and amount of impact (including all clearing, back fill, excavation, riprap, retaining walls,
other fill, etc.) above the normal po9 l lake level and 50 feet land -ward in square feet or 1:J,pres:
-*77VNS �% ,x,/4,4, L 3I ,q � S,yoiau••vte 0 Afolr t %-,cr,&c-
b. Please describe the vegetation above the normal po 1 lade level, and 50 feet 1 d- and to be
impacted (number of trees for instance): �� Q A41 (�IWPJ %W,7'74 %l
l� by oINc-r ,9,01VI • X r veo, G0*�s c44e. /*
,4vw� c.1;!/ 6c r •
,!r -G -
ApplicanVAgent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 3 of 4

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May 1, 2018
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Swms: Esd, HERE, Gartniq USGS. Intonsp INCREMENT P. N
Japan, METI, Earl Chha (Hong Konq� Esd Kana, Esd (Thailand),
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lot location
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May 1, 2018
Roads DO
Structures
Parcels
County Boundary
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0 30 80 120
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Japer% METI, Earl Chha (Hong Konp� Ear! Karoo, Earl (Thaga4,
OpenStmalMapcorMbutars,and t oGIS User Comm liy