Laserfiche WebLink
( riURE OF ACTIVITY (Descrip[bn of project, include all features) <br />/ / it-kc ~xcAvRTSp~~ or ~,2,A~ cl, Dc P~S3'jrj .~N(J <br />/ 'FCL (.A n't A-~- rarer p t= S f{ o (Z Et_.-i 1~1 C <br />19. PROJECT PURPOSE (Describe [he reason or purpose of the project, see insvuctions) <br />o '~QccLC~'S G-{~1~~SC1_ '1~c'PcS-i "S <br />USE BLOCKS 20-22 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED <br />20. REASON(S) FOR DISCHARGE / <br />N J ~. <br />21. TYPE(S) OF MATERIAL BEING DISCHARGED AND/ THE AMOUNT OF EACH TYPE IN CU61C YARDS <br />N /ra <br />22. SURFACE AREA IN ACRES OF WETLANDS OR OTHER WATERS FILLED (see insvuctions) <br />n/o ;,iETL.4rvOS %~ Oc r=.=LLE~ v. /S/~cr of (.I~c12r')r~)S ~Ta <br />~c f2cOC.~cEr) ~ ~~r2.iTntC7 Fz c`LVaM !~ ciu~l ~R accc~S o [= p~rJS•Sl-( . <br />23. IS ANY PORTION OF THE WORK ALREADY COMPLETE? YES O NO O IF YES. DESCRIBE THE WORK <br />24. ADDRESSES OF ADJOINING PROPERTY OWNERS, LESSEES, ETC. WHOSE PROPERTY ADJOINS THE WATERBODY (If more roan <br />can be en[eretl here, please attach a supplemental list) <br />~ ~~ <br />25. LIST OF OTHER CERTIFICATIONS OR APPROVALS/DENIALS RECEIVED FROM OTHER FEDERAL, STATE, OR LOCAL AGENCIES <br />FOR WORK DESCRIBED IN THIS APPLICATION <br />AGENCY TYPE APPROVAL' IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED <br />MSi~ti-~ LT <br />rn~Qt3 m-z~i-c4,o 9v3 It to 3 <br />~ERMSi <br />' Would Include but is not restricted to zonin , buildin and flood lain ermits. <br />26. Application is hereby made for a permit or permits to authorize the work described in thi pplicatlon. t certify that the information <br />in this application is complete and accurate. I further certify [hat I possess the authority to ertake the work described herein or am <br />actin as th dul r utho zed agent of the applicant. <br />,~ { (z 1 2 b <br />ATURE F A LICANT DATE SIGNAT F AGENT DATE <br />The application must be signed by the person who desires to undertake [he proposed activity {applicant) or it may be signed by a duly <br />authorized agent i( the statement in block 11 has been filled out and signed. <br />18 U.S.C. Section 1001 provides that: Whoever, in any manner within the Jurisdiction of any department or agency of the United <br />Slates knowingly and will fully falsifies, conceals, or covers up any [rick, scheme, or disguises a material fact or makes any false, <br />facticious, or fraudulent statements or representations or makes of uses any false writing or document knowing same to contain any <br />