Laserfiche WebLink
<br />I <br /> <br />5. NAWES AHa ,.l"'Il'\CC~~C: OF- An !Ql.M3 PROPERTY OWNERS, II:~;';Q ETC., WH06E PAOt'EATV A&JiO ADJOINS TIE WATERWAY <br />8, WATERllOOY AHO LOCATION ON WATERllOOY WHERE ACTIVITY ElQSTS OA IS PRllfI06EIl <br /> . <br />7, LOCATION ON lAND WI1ERE AC11VITY EXISTS OA IS PRllfI06EIl <br /> AI"V"lDI:SS' <br /> STREET, ROAD, ROUTl: OA OTHER 0ESCAIPT1VE LOCATION <br /> COUH1Y STATE l>>'CODE <br /> lOCAl. GOVERNING eooy WITH .!I.JRtSlltCTIOh OVERSITE <br />8. .. anv porllQf'l 0' ltMI eclMIy lor wNeh IUlhDrilahon .. DlUhI now c.ampIIlIe? a YES 0110 <br /> It ana... II -.,.- grw INION. month n ... IN lCIiwtly ..~. ......Ihe....w.g work on the ~..... <br />8, u.a .. 8PPfov'" or C8fldlC8ban1 and .... ,....,.. ',om oIhIf ....... w....... .. QI' ~ ~ ... .., ......-., c:anIII~ cUl;NrgN Of o&t. <br /> -... -._ in Ihoa _...., <br /> ISSUING AGENCY TYPE ~A4 IDEHTFlCATION 110, DATE Of' APPliCATION DATE Of' AI'PROVA4 DATE Of' 0ENIAl. <br />10, Apptcallan II her" fNd8 'Of . ..,mII Of perrNlI &0 unarw. IhiI K~ dlllglbed,.,.,.. I cerldy lhM I ... I..... with 1M N1IOffnlllOn con"'ned tn lhe <br /> ~IIQn, end IMllO lhe ta.II 01 _ .... ';0 Mid..... IUIOh Wurmeaaun illI.... ~ Md....... t Iur.... '*~ ""'1 puuMU the .whOrl'" to <br /> ...-......... 11I'_ _..,..~. "'" 1lIlIw__" ..........' <br /> SIGNATURE Of' APPUCAHr DATE SIGNATURE OF_ DATE <br /> The .ppl,cabOll muSI be SIgned lll' lI>e person wIIo deSlr.s ID undenaM /tie proposeo acllol'/y (app/icanI) or II mar be SIgned br a du/r <br /> auttloflzfld agenl,f lI>e SI._ in bIocII 3 hu _ IiIIed 0UI1IIId $IfIII8d. <br /> 18 U.S,C, SeeIlOl1I001 provides lhaI: W_,", any manna< wolllon Ihe JUllIdocllOn 0/ i/IIY depanmenl 01_ 0/ The Un,l8d S"'..S <br /> knowl/lg/y i/IIll wlll'ulIy falsi'..... conceaII, 01 COV<llS up by any vlCll. scheme. or llev1C8 a ..-...fact 01 __ any 1aIse, ",,,...... or Irauoulenl <br /> _10 01 ","r_1alIOna or __ or ..... i/IIy IaIse wrlllng or lIocunw1lluloWtng _ 10 cor-. any ..... IiclIlIOuI or <br /> lraudulenl SIalemenI 01 8rl1ry, shall be tined nol more Ihan $10.000 OIlffl\lfIIllIIll nol more IIIan live yoIIfl, 01 -. <br /> <br />,-",--..., <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />II <br /> <br />I <br /> <br />u_.-....._.......... <br />