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APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT OMB APPROVAL N0.0710-0003 (33 CFR 325) Expires December 31, 2004 The Public b•,aden for this mlledion of information is estimated to average 10 hours pet response, although the majority of applications should requve 5 hours or less. This includes the time for reviewing instructions, seardiing existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions fot reducing this burden, to Department of Defense, Washington Headquarters Service Directorate of Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302; and to the Office of Managemeirt and Budget, Paperwork Reduction Project (0710-0003), Washington, DC 20503. Respondems should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does nok display a current]y valid OMB control number. Please DO NOT RETURN your form to either of those addresses. Completed applications must be submitted to the District Engineer having jurisdiction over the locazion of the proposed activity. PRIVACY ACT STATEMENT Authorities: Rivers and Harbors Ad, Section 10, 33 USC 403; Clean Water Ad, Section 404, 33 USC 1344; Marine Protection, Research and Sanctuaries Ad, 33 USC ]413, Section 103. Principal Purpose: htformation provided on this form will be used in evaluating the application for a permit. Routine Uses: This information maybe shared with the Departmem of Justice and other fakral, state, and local govemmeM agenties. Submission of requested information is voluntary, however, if information is nd provided the permit application canna be evaluated nor can a permit be issued. One sct of original drawings or good reproducible copies which show the location and character of the proposed activity must be attarTied to this application (see sample drawings and instructions) and be submitted to the District Engineer having jurisdiction over tbe location of the proposed activity. An application that is not completed in full will be returned. (ITEMS 1 77IRU 4 TO BE FILLED BY7NE CORPS) 1. APPLICATION NO. 2. FIELD OFFICE CODE 3. DATE RECE(VID 4. DATE APPLICATION COMPLETID (!TENS BELOW TO BE FILLED BYAPPLICAN7) 5. APPLICANT'S NAME 8. AUTHORIZED AGENT'S NAME AND TITLE (an agent it raw required) Loveland Ready Mtz Concrete, Ina Mlchaet S. Savage, Prtnccpal 6. APPLICANT'S ADDRESS 7. AGENT'S ADDRESS Savage and Savagq Ion P.O. Boz 299 464 W. Snmae Ct Loveland, CO 80539-0299 LoeisviBe, Colorado 80027 7. APPLICANT'S PHONE NOS. W/AREA CODE 10. AGENT'S PHONE NOS. W/AREA CODE a Residence a Residence 303 666 7372 b. Busi~ss 970 667 5422 b. Business 303 666 7372 Fax 3036656808 c. E-Mail sawgeaedsavagcQaeartWiekoet 21. STATEMENT OF AUTHORIZATION I hereby authorize Savage amd Bounce. lea to act in my behalf as my agent in the processing of this applit~tion and to furnish, upon request, supplememal information in support of this Permit appGwtion APPLICANT'S SIGNATURE DATE NAME, LOCATION AND DESCRIl'TION OF PROJECT OR ACTIVITY 12. PROJECT NAME OR TffLE (see bvdveiiona) Green and Croissant Project 13. NAME OF WATERBODY, IF KNOWN (tfoppltrn8le) 14. PROTECT STREET ADDRESS (fjapplxvble) Sig Thompson River No Project Street address I5. LOCATTON OF PROJECT Weld Colorado COUNTY STATE 16. OTHER LOCATION DESCRIl'710NS, IF KNOWN (see mmuctions) W'/.N'/: of Section 30, Township 5 North, Range 67 West, 61h Prime Meridian, Weld, Coaoty, Colorado i7. DIItECTfONS TO THE SITE SE corner of Weld County Road 13 and Weld Coaaty Road 54 ENG FORM 4345, Jul 97 EDTIION OF FEB 941S OHSELETE (Proponent: CECW-Ott)