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LOCAL--STA"I'E--FEDERAL PROTECT tiOTiFICATTON FOR~,t ~'
<br />~ mcv use this farm to notify tJze bfwusota Ikparnnust of Nattual Rera:rtr- the Amry Caps ~ Eng~~ ~I ~u c~.,~, ~
<br />,nwicipcl ojfec~s of a proj«z or wcr',e y~ prnpo,se whlrh may faB within their f~rzsdicdon. ?7~e agvseies should advirr yct.r of tJzcir 'I
<br />jurf l'ir_ttas, rf a'ry, within 4S days of rcuipt of this notifccation. 7tus form is pro•,~iL'ut cs a convercio:r~ and i~ are is optioncL you
<br />»y~ ~Y°U "`uh, apP'~' ja PQT'uts a m_ttitorIIadons urina stmsdard agauy fags. Fill o~ct this fa:n compldcly and mail a copj, ri~tt
<br />plttrts, tr~~ d.G to each of the ab^asdes listed oz the trverse of the form. Ktep a copy of all materials subnuttcd jw•yacr recordx Yeti
<br />mttsr obtain all rrllttircd cz:tlsor~ons b{Tct-e bc~vrnin~ word Ytolatiars.s o{ local Star{ or Fcdn-a1 Irrws may be purcishcblr bti
<br />ac~m+ ircistrative, rnil ardlcr crimina! persaltiaz ~ ~ ~ /
<br />[. Applic_nt's Namc (First, Last, hi.i.) / ?.uthorizcd A!gcat, if arty ( / A.rca Cock, Telephone
<br />C i ~ h o (' v i I o . TIO wa . C; I ( ~ 5`94-~`G ~~
<br />Addr Street, RFD, Box Numtxr, City, State, Zip Cede)
<br />~~ /V, vr~G~o/'ta S{~a+'c~icw tr'? 11/ SSIoZ(
<br />11. LOCATION OF PROPOSED PROJECT (ATTACH DRAFYING SHOIf<ING NOI~ TO GET TO SITE)
<br />Government lot(s) Quaver Section(s) Section(s) No. Towtuhip(s) No. Range(s) No. Lor; Biotic, Subdivision
<br />5~% 3 S 3 O a 3 S8'ts3 1. D~,.assa />*d~' STS
<br />Fire No., Box No., or Project Address County I{rork will affect lal~:e wetland waterway erg pr action
<br />Waterboa`y Name, No. (if la:own} L..a lCe Q tra 350
<br />LIT. F_ST7r1fATED PROTECT COST.• S S~ ~ O C7 LENGTH OF SNORE AFFECTED (i,s Jett):
<br />[!! Volume of fill or excavation (cubic yds.): ~ C Y Area filled or excavated is acrzs, or sjp p square jeer.
<br />(NOTE: You may substitute dimensions)
<br />Y.• TYPE OF WORK AND A1ZL1! (C,7zcdc all that appty): hTLt. EXC.tY.tTE Rf_:/'NK CONJl7lUCl
<br />REMOVE DRAIN I1riM
<br />~SHORELIlYE WETZrtND F'ATERWAY DOCK CtILYERT BRIDGE LAKE
<br />~iCC.E.~S PriTN RIPRAP SAND BI~INKF.T OT7fER (dccribc):
<br />HrETI..AND TYPE(S) AND ACRF~iGE(S) PROPOSED T'O BE Flt t >: n/DRAINED:
<br />r1ftG:h drawings ar-d plans. Inchldc a dcxrsr'aaorc of arty prapazcd corrt~ciatay rnrngarorc Imlxxt~u: Idovitry arty dupa:al arsd borrow mYas
<br />Dzscrbe the work below; how it would be done, what tquiancnt would 6e used:
<br />~p ~t,T~a n s.~ S .L ~,.~~ 4 c.~e pt
<br />L7. PROJECT PURPOSE (wiry is this project neede/d~~--what benzfts willl~it provide?):
<br />RE n,cud w n v4r~T'd~ Sea ~ -^+~n7 •t'ro r.. ?~.e ~.Q +Ge`
<br />VZI. ALTFRVi27-IVES (dcscribr any othersus or mtthocis that cou.fd br used w achieve the purpose of your protect wicite avoiding
<br />t,•r minimizing wetland/wato impacLT: Attach addr.'an-al sheds, if needed).
<br />~'r{-i- Chow.ber Try be t'r-gTalfc~ by -T7,c Cl~ ctT Tlt~ T~-'r+..c o-~
<br />~~,~,~ r~ecansT~~~7r'®r1.
<br />VIl1. DATES-- Activity proposed to begin on: ~ -p7 Be complzted: /O - 7
<br />Has any of the work been done? NO_~ YES (identify any complzred work on drawing}.
<br />LY. ADJOINGVG PROPERTY OIt~NERS (Attach list if more than two).
<br />Namc Address Ciry Stare Zip
<br />I. IQe~s.i~cnT 319~f W. owas~o R(~~ Sli+o.e~~eu /I~ -S"5~2~
<br />? kcsi~ e~T' ~19Z~ W, d ~~-s so CiL
<br />Y PER,'.lITS have been received (enter an ) or already applied for {enter an A) front: DrVR ARM1IY.CORPS
<br />COUNTY _~TOI!/,V/CITY tirATERSHE'D DlSTR1CT ttilN. POLLUTION CONTROL AGENCY.
<br />Has an archaeological sun•ey of the project site been done? Ijso; by whore: -
<br />Xl. I t•.ererry notify the rceipirncs of this form of ti.c project proprued hazin and request that 1 be at(vircd of arty prrmics or other- W
<br />de!erminati~}rs eertconirg this project tt'.at I must obtain. I tuuivstand that proceeding with wank before all req ~ ^, ~~ ` _..J~,,C, ~s
<br />are obtttirteet may subje mr to Federal, State, and/or la:al adtninisvative, avil and/a criminal pa:altiegs. .1~'-`' " ~ ~~:~i;1
<br />,a,
<br />Signartrr of Persots Praposing Project or Agent __ .`b,•.`<'~ '~~~
<br />< < < PLE,-LSE C-IREFULLY R~iD AND CO,ifPLE7E I3~! CK OF FORhf > > > -'_ ,
<br />-Yf~ ~l
<br />i~r, - ~~ t-`v/
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