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APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT OMB APPROVAL NO. 0710-003 <br />(33 CFR 325) <br />Public reporting burden for this collection of information is estimated to average 5 hours per response, including the time for reviewing instructions, <br />Searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send <br />comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to <br />Department of Defense, Washington Headquarters Service Directorate of Information Operations and Reports, 1215 Jefferson Davis Highway, Suite <br />1204, Arlington VA 22202-4302; and to the Office of Management and Budget, Paperwork Reduction Project (0710-003), Washington, DC 20503. <br />Please DO NOT RETURN your form to either of those, addresses. Completed applicatioris must be submitted to the District Engineer having jurisdiction <br />over the location of the ro osed activit . <br />PRIVACY ACT STATEMENT <br />Authority: 33 USC 401, Section 10; 1413, Section 404. Principal Purpose: These laws require permits authorizing activities in, or affecting, navigable <br />waters of the United States; the discharge of dredged or fill material into waters of the United States, and the transportation of dredged material for the <br />purpose of dumping it into ocean waters. Routine uses: Information provided on this form will be used in evaluating the application for a permit. <br />Disclosure: Disclosure of requested information is voluntary. If information is not provided, however, the permit application cannot be processed nor <br />can a permit be issued. <br />One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this <br />application (see sample drawings and instructions) and be submitted to the District Engineer having jurisdiction over the proposed activity. An <br />application that is not completed in full will be returned. <br />(I I tM5 1 THRU 4 TO BE FILLED BY THE CORPS). <br />1. APPLICATION NO. 2. FIELD OFFICE CODE 3. DATE RECEIVED 4. DATE APPLICATION COMPLETED <br />fl I FMS F~FI flV1/ T(l RF FII I Frl RV OpDI II^~AIT\ <br /> <br />5. APPLICANT'S NAME --. <br />8. AUTHORIZED AGENT'S NAME & TITLE (an agent is not required) <br />Western Gravel Inc. Ben Miller (Engineer:Greg Lewicki and Associate <br />6. APPLICANT'S ADDRESS 9. AGENT'S ADDRESS <br />3001 N. Townsend 11541 Warrington Ct <br />Montrose, CO 81401 Parker, CO 80138 <br />7. APPLICANT'S PHONE NUMBERS WITH AREA CODE 10. AGENT'S PHONE NUMBERS WITH AREA CODE <br />a. Residence NA a. Residence NA <br />b. Business (970) 249-2431 b. Business (720) 842-5321 <br />11 • STATEMENT OF AUTHORIZATION <br />I hereby authorize Greg Lewicki and Associates to act in my behalf as my agent in the processing of this <br />application and to.furnish, upon request, supplemental information in support of this permit application. <br />APPLICANT'S SIGNATURE DATE <br />IVHIVIC_ LIA.H 1 Il JIV ~\IVI ] I)hti( :KIN I I( 11\I f 1F VKf l II-(' I flA 0('TI\/ITV <br />12. PROJECT NAME OR TITLE (see instructions) <br />Olathe Wetland Bank <br />13. NAME OF WATERBODY, IF KNOWN (if applicable) 14. PROJECT STREET ADDRESS (if applicable) <br />Uncompahgre River <br />15. LOCATION OF PROJECT <br />Montrose CO <br />COUNTY STATE <br />16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions) <br />A tract of land located within Section 22 of Township 50N, Range 10W of the 10th Prime Meridian. <br />17. DIRECTIONS TO THE SITE <br />Leave Olathe along Chruch Ave for 0.4 miles. Church Ave becomes Church Rd continue for 0.2 miles. Turn left onto S. <br />River Rd. Continue for 0.8 miles. Site is located on the eastern side of the road. <br />ENG FORM 4345 -ONLINE CESPK-CO-R <br />