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U.S. ARMY CORPS OF ENGINEERS <br /> REQUEST FOR CORPS JURISDICTIONAL DETERMINATION <br /> 'Authorities Rivers and Harbors Act,Section 10,33 USC 403,Clean Water Act,Section 404,33 USC 1344,Marine Protection, CORPS USE ONLY: <br /> Research,and Sanctuaries Act,Section 103,33 USC 1413,Regulatory Program of the U.S Army Corps of Engineers,Final Rule for DATE RECEIVED: <br /> 33 CFR Parts 320-332 Principal Purpose.The information that you provide will be used in evaluating your request to determine <br /> whether there are any aquatic resources within the project area subject to federal jurisdiction under the regulatory authorities <br /> referenced above Routine Uses This information may be shared with the Department of Justice and other federal,state,and local <br /> government agencies,and the public,and may be made available as part of a public notice as required by federal law Your name and <br /> property location where federal junsdiction is to be determined will be included in the approved jurisdictional determination(AJD),which <br /> will be made available to the public on the District's website and on the Headquarters USACE website Disclosure Submission of <br /> requested information is voluntary,however,if information is not provided,the request for an AJD cannot be evaluated nor can an AJD PROJECT NO.:_ <br /> 1. PROPERTY LOCATION: 2.REQUESTOR CONTACT INFORMATION: <br /> Street Address: Weld County Parcel# 105924000023 Typed or Printed Name: JC York <br /> City/Township/Parish: Milliken Company Name: J&T Consulting, Inc. <br /> County:Weld State: CO Street Address: 305 Denver Avenue, Suite D <br /> Acreage of Parcel/Review Area for JD: 134 acres City: Fort Lupton State: CO ZIP: 80621 <br /> Section: 24 Township: 4N Range:67W Phone Number: 3038576222 <br /> Latitude: 40.300558° N Longitude:-104.834744*W E-mail: jcyork@j-tconsulting.com <br /> ( r h r Parp/gam,,Please Include the center PPInt of LhA loosed alignnn n ) <br /> 3. MAP: Please attach a survey/plat map and vicinity map identifying location and review area for the JD. <br /> 4. REASON FOR REQUEST(check as many as applicable): <br /> 01 intend to construct/develop a project or perform activities on this parcel which would be designed to avoid all <br /> aquatic resources. <br /> intend to construct/develop a project or perform activities on this parcel which would be designed to avoid all <br /> jurisdictional aquatic resources under Corps authority. <br /> I intend to construct/develop a project or perform activities on this parcel which may require authorization from the <br /> OCorps, and the JD would be used to avoid and minimize impacts to jurisdictional aquatic resources and as an initial <br /> step in a future permitting process. <br /> 01 intend to construct/develop a project or perform activities on this parcel which may require authorization from the <br /> Corps; this request is accompanied by my permit application and the JD is to be used in the permitting process. <br /> intend to construct/develop a project or perform activities in a navigable water of the U.S.which is included on the <br /> district Section 10 list and/or is subject to the ebb and flow of the tide. <br /> QA Corps JD is required in order to obtain my local/state authorization. <br /> OI intend to contest jurisdiction over a particular aquatic resource and request the Corps confirm that jurisdiction <br /> does/does not exist over the aquatic resource on the parcel. <br /> 01 believe that the site may be comprised entirely of dry land. <br /> 00ther: <br /> 5.TYPE OF DETERMINATION BEING REQUESTED: 6. OWNERSHIP DETAILS: <br /> QI am requesting an approved JD. 01 currently own this property. <br /> 01 am requesting a preliminary JD. 01 plan to purchase this property. <br /> 01 am requesting a"no permit required" letter as 1 OI am an agent/consultant acting on behalf of the <br /> believe my proposed activity is not regulated. requestor. <br /> 01 am unclear as to which JD I would like to request and DOther(please explain:) <br /> require additional information to inform my decision. <br /> By signing below,you are indicating that you have the authority,or are acting as the duly authorized agent of a person or entity with such authority,to <br /> and do hereby grant Corps personnel right of entry to legally access the site if needed to perform the JD.Your signature shall be an affirmation that you <br /> possess the requisite property rights to request a JD on the subject property. <br /> Date: 2- <br /> PAGE OF DEC 2016 <br />