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18. NATURE OF ACTIVITY (Description of project, include all features) <br />Wetland Bank: Please See Attached Documentation <br />19. PROJECT PURPOSE (Describe the reason or purpose of the project, see instructions) <br />Wetland Bank: Please See Attached Documentation <br />U5t t3LUGK5 ZO-22 IF DREDGED AND/(~R FII I MATFRIAI I~ TO RF fIIC(`NAR(,Fll <br />20. REASON(S) FOR DISCHARGE <br />NA <br />21. TYPE(S) OF MATERIAL BEING DISCHARGED AND THE AMOUNT OF EACH TYPE IN CUBIC YARDS <br />NA <br />22. SURFACE AREA IN ACRES OF WETLANDS OR OTHER WATERS FILLED (see instructions) <br />NA <br />23. IS ANY PORTION OF THE WORK ALREADY COMPLETE? YES ~ NO ~ IF YES, DESCRIBE THE WORK <br />24. ADDRESSES OF ADJOINING PROPERTY OWNERS, LESSEES, ETC. WHOSE PROPERTY ADJOINS THE WATERBODY (If more than <br />can be entered here, please attach a supplemental list) <br />Please See Attached Documentation <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 />CDMG 110 Permit M-1984-108 1984 1984 NA <br />County Special Use NA 1984 1984 NA <br />County PUD NA Concurrent NA NA <br />CDWR Gravel Well NA Concurrent NA NA <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 this application. I certify that the information <br />in this application is complete and accurate. I further certify that I possess the authority to undertake the work described herein or am <br />acting as the duly authorized agent of the applicant. <br />SIGNATURE OF APPLICANT DATE SIGNATURE OF AGENT DATE <br />The application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly <br />authorized agent if 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 />States knowingly and will fully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, <br />facticious, or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any <br />false, fictitious or fraudulent statements or ent ,shall be fined not more than $10,000 or im risoned not more than five ears or both. <br />ENG FORM 4345 -ONLINE CESPK-CO-R <br />