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HomeMy WebLinkAboutJARPA - SHX Application - 1/29/2009 f ; Application for Streamlined Process for FISH HABITAT ENHANCEMENT PROJECTS Addition to the Joint Aquatic Permit Application Form (JARPA) Under recent laws,you may qualify for a streamlined permit process with no fees,if your project is designed to enhance fish habitat. If your project meets the requirements below,you are entitled to the streamlined Hydraulic Project Approval(HPA) process,exemption from the State Environmental Policy Act,and exemption from all local government permits and fees. To apply for the exemption process,the applicant must provide on the same day,the JARPA form and this cover addition to: the Department of Fish and Wildlife(WDFW)and all applicable Local Government planning and permitting departments. Local governments have 15-days to provide comments to WDFW,who will use these comments to aid them in making decisions(see below for details). APPLICANTS - To QUALIFY for the fish habitat enhancement exemption von must check at least one each from A and B: A)Projects must accomplish one or more of the following fish habitat restoration tasks(check which one applies): Removal of human-made fish passage barriers; or ❑ Restoration of an eroded or unstable stream bank using bioengineering techniques;or ❑ Placement of woody debris or other in-stream structures that benefit naturally reproducing fish stocks. AND B)Projects must also be approved in one or more of the following ways(check which apply,and provide details as requested): ❑ By WDFW,through the Salmon Enhancement,or Volunteer Cooperative Fish and Wildlife Enhancement Programs;Provide project name, and who at WDFW approved the project ; ❑ By the sponsor of a watershed restoration plan as provided in chapter 89.08RCW;Provide title ofplan and date, and approving or sponsoring agency ; By the Department of Fish and Wildlife as a department-sponsored fish enhancement or restoration project; ❑ Through the review and approval process for the Jobs for the Environment program; ❑ Through the review and approval process for Conservation District sponsored projects,where the project complies with design standards established by the conservation commission through interagency agreement with the United States Fish and Wildlife Service and the Natural Resource Conservation Service;Provide approval date and name of Conservation District approving project ;or ❑ Through a formal grant program established by the legislature or the Department of Fish and Wildlife for fish habitat enhancement or restoration(currently the Dept.of Transportation is handling grant applications-contact Peter Downey at (360)705-7492 for information)Provide grant application date , and circle status-Approved,Denied, or Pending. To APPLYfor the Exemption-if you have checked a box from both A and B above,complete the following: 1) Submit this'cover letter and a complete JARPA form as an application for the fish habitat enhancement exemption to the Local Government planning department,and WDFW. These applications must be submitted on the same day starting a 15-day comment period. If significant concerns are raised during the 15-day comment period regarding adverse impacts that cannot be addressed through HPA conditions,WDFW can determine that the project does not qualify for the exemption process.If this determination is made,the applicant may re-apply to WDFW,the applicable Local Government,and any other applicable permitting agency for approval under the full permitting process. Provide 1)name and number of habitat biologist at WDFW you applied to qis-30 4� and 2)what local government you applied to ► v's or► Geun-1 ; 2) Apply for all other Federal and State permits needed as defined in the JARPA Wn.(Fill in waters of the state will require a 404 permit from the Corps of Engineers,and possibly a 401 Water Quality Certification from Ecology). 3) The Only work covered by the exemption process must be for fish habitat enhancement. If only a piece of your project is for habitat enhancement,the remainder of the project must be covered by the full permitting process. 4) If WDFW determines that your project meets the criteria for the exemption,your project is exempt from SEPA and from local government permits and fees. You will have an answer from WDFW within 45 days of the receipt of this cover letter and complete JARPA form. LOCAL GOVERNMENTS: PLEASE NOTE—you only have 15 days to review the projects and provide comments to WDFW or your comments will be considered waived. Per the new law, you are responsible for the following: 1. You must accept the JARPA application form and this revised cover addition for project review; JARPA\2879form.doc,4/27/98,page 1 Of 2 ' 2. If�he Local Government chooses to comment on the project,comments(support or objectio )must be provided to the WDFW local habitat biologist responsible for the project area within 15-days of receipt of the JARPA ford; 3. If determined by WDFW that the project meets the habitat enhancement exemption criteria, EPA and all local government permits are considered exempt and consistent with the revisions to the WACs,and local government fees are waived. 4. The law determines that"fish habitat enhancement projects that conform to the provisions of the act are determined to be consistent with local shoreline master programs". DEPARTMENT OF FISH AND WILDLIFE: 1. Upon receipt of a complete JARPA and request for the fish habitat exemption process,review the proposed project plan for compliance with the requirements listed in section 1 and 2 of 2SHB 2879(also listed on page 1,applicant section#A and B). a) If JARPA is incomplete or if it is determined that a project does NOT meet the exemption criteria,contact the applicant and local government planning department and inform them the project does not quali for the exemption. Return JARPA to the applicant. The applicant may reapply to WDFW,the applicable Local Governmen and other permitting agencies for approval under the full permitting process. b) If JARPA is complete and the project meets the criteria,start the HPA 45-4ay exemption process(defined below); 1. WDFW must allow 15 days for interested parties,and local governments to provide comments on the project—no approval action can be taken within the first 15 days of receipt of the JARPA; 2. If comments are received,WDFW will decide whether the concerns raised can be mitigated hrough conditions of the HPA—if yes, continue to#4. If no,WDFW will notify the applicant and applicable Local Government. The applicant may reapply to WDFW,the applicable Local Government and other permitting agencies for approval under the full permitting process; 3. WDFW must approve or deny the HPA, or make a determination that the proposed ork does not qualify for the exemption process within 45 days. JARPA\2879form.doc,4/27/98,page 2 of 2 ---------------------------------------, eoA� A O O 9 M i AGENCY USE ONLY ; US Army Carps Date received. of Engineers WAS H I N GTO N STATE » , ' $eett{e District I ; Joint Aquatic Resources Permit Application (DARPA) Form hel Agency reference#: Tax Parcel#(s): USE BLACK OR BLUE INK TO ENTER ANSWERS IN WHITE SPACES BELOW. t ; Part 1—Project Identification Unique project information that makes it easy to identify. hel '--------------------------------------' la. Unique Project Identifier Number(UPI#) hf eM Don't have one yet?Get one at http://www.epermitting.wa.gov or call the Washington Governor's Office of Regulatory Assistance at(800)917-0043. 204127-09-01 1 b. Project Name (Examples: Smith's Dock or Seabrook Lane Development) hf elpl McTaggert Creek Restoration Part 2—Applicant The person or organization legally responsible for the project. hel 2a. Name (Last, First, Middle)and Organization(if applicable) Tacoma Power, ATTN: Mathew Wilson 2b. Mailing Address (Street or PO Box) 3628 South 35t" Street 2c. City, State, Zip Tacoma, WA, 98409 2d. Phone(1) 2e. Phone(2) 2f. Fax 2g. E-mail ( 253) 502-8226 ( 253) 502-8196 ( ) mwilson@ci.tacoma.wa.us Part 3—Authorized Agent or Contact Person authorized to represent the applicant about the project. (Note: Authorized agent(s) must sign 11 b. of this application.) hel 3a. Name (Last, First, Middle) and Organization (if applicable) 3b. Mailing Address (Street or PO Box) 3c. City, State, Zip 3d. Phone(1) 3e. Phone(2) 3f. Fax 3g. E-mail JARPA 2009 Page 1 of 14 Part 4—Property Owner(s) Lopi Contact information for people or organizations owning the property(ies)where the project will occur. hf elpl ® Same as applicant. (Skip to Part 5.) ❑ Repair or maintenance activities on existing rights-of-way or easements. (Skip to Part 5.) ❑ There are multiple property owners. Complete the section below and use JARPA Attachment A for each additional property owner. 4a. Name (Last, First, Middle)and Organization (if applicable) 4b. Mailing Address (Street or PO Box) 4c. City, State, Zip 4d. Phone(1) 4e. Phone(2) 4f. Fax 4g. E-mail Part 5—Project Location(s) Identifying information about the property or properties where the project will occur. hf eU ❑ There are multiple properties or project locations (e.g., linear projects). Complete the section below and use JARPA Attachment B for each additional property. 5a. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5n.) hel Provided in section 5n 5b. City, State, Zip(If the project is not in a city or town, provide the name of the nearest city or town.) hel Provided in section 5n 5c. County hf eM Mason County 5d. Provide the section, township, and range for the project location. h[ elM % Section Section Township Range NW 1/4 7 22 North 4 West 5e. Provide the latitude and longitude of the project location. hel + Example:47.03922 N lat./-122.89142 W long 47.41399 N lat. / -123.24126 W long. 5f. List the tax parcel number(s)for the project location. hf eip] • The local county assessor's office can provide this information. 422070000000 5g. Indicate the type of ownership of the property. (Check all that apply.) hei ❑ State Owned Aquatic Land ❑ Tribal ❑ Private ® Other publicly owned (federal,state,county, city, special districts like schools, ports, etc.) JARPA 2009 Page 2 of 14 '5h. Contact information for all adjoining property owners, lessees, etc. (If you need more space, use JARPA Attachment C.) h[ eM Name Mailing Address Tax Parcel # (if known) Eric Beach Green Dimaond Resource Co. Unknown Green Diamond Resources P.O. Box 9001 Shelton, WA 98584 ................................................................................................................................................................................................................................................... ................................................................................................:................................................................................................................................................... ....................................................................................................................................................................................................................... 5i. Is any part of the project area within a 100-year flood plain? hel ® Yes ❑ No ❑ Don't know 5j. Briefly describe the vegetation and habitat conditions on the property. hel The property in question encompasses a 400 foot stretch of McTaggert Creek that has been previously dammed and diverted into a man-made channel that is not fish passable. The property is a highly vegetated timberland with a sparse forest floor of predominantly salmon berry and other native plants of the Pacific Northwest. 5k. Describe how the property is currently used. [L9!PJ The property is currently used to redirect the natural flow path of McTaggert Creek by use of an existing diversion dam into the adjacent Deer Meadow Creek. The diverted water currently flows over a man-made timbered spillway and a 4.5' steel fish barrier. 51. Describe how the adjacent properties are currently used. hf ell The project boundaries are adjacent to Cushman Dam No. 1, a hydroelectric dam on the North Fork of the Skokomish River in Mason County, Washington forming Lake Cushman. This dam provides 127 million kilowatt- hours annually to the Tacoma Power system. The other surrounding areas are made up of timberland managed by Green Diamond Resources and owned by the U.S. Forest Service. DARPA 2009 Page 3 of 14 5m. Describe the structures (above and below ground) on the property, including their purpose(s). n[ eM The structures existing within the project boundaries are a diversion dam, timbered spillway, and 4.5' steel fish barrier. Currently the diversion dam is used to redirect the natural flow of McTaggert Creek into the adjacent Deer Meadow Creek. The steel fish barrier, timbered spillway and diversion dam are currently providing circumstances that deem McTaggert Creek as a fish barrier. 5n. Provide driving directions from the closest highway to the project location, and attach a map. hel Directions from I-5 to Nf-2340 and Nf-2202 B intersection 4: Merge onto 1-5 S toward PORTLAND. 0.9 mi 5: Merge onto US-101 N via EXIT 104 toward ABERDEEN/PORT 35.0 mi ANGELES. 6: Turn LEFT onto WA-119. 3.7 mi 7: Stay STRAIGHT to go onto N LAKE CUSHMAN RD/WA-119. 0.3 mi 8: Turn LEFT onto N STANDSTILL RD S (Portions unpaved). 0.4 mi 9: Turn SLIGHT LEFT onto NF-2202 (Portions unpaved). 0.2 mi 10: Continue on NF-2202 until intersection with Nf-2340 Part 6—Project Description 6a. Summarize the overall project. You can provide more detail in 6d. LheM The general scope of this project is to rehabilitate McTaggert creek to its original state by removing the man- made diversion dam and reconfiguring the altered creek channel to a stable state. This will not only restore the creek to its original channel, but allow for McTaggert Creek to again become fish passable. 6b. Indicate the project category. (Check all that apply.) h( elm ❑ Commercial ❑ Residential ❑ Institutional ❑ Transportation ❑ Recreational ❑ Maintenance ® Environmental Enhancement 6c. Indicate the major elements of your project. (Check all that apply.) hf elpl ❑ Aquaculture ❑ Culvert ❑ Float ❑ Road ❑ Bank Stabilization ® Dam /Weir ❑ Geotechnical Survey ❑ Scientific Measurement ❑ Boat House ❑ Dike/ Levee /Jetty ❑ Land Clearing Device ❑ Boat Launch ❑ Ditch ❑ Marina / Moorage ❑ Stairs ❑ Boat Lift ❑ Dock/ Pier ❑ Mining ❑ Stormwater facility ❑ Bridge ❑ Dredging ❑ Outfall Structure ❑ Swimming Pool ❑ Bulkhead ❑ Fence ❑ Piling ❑ Utility Line ❑ Buoy ❑ Ferry Terminal ❑ Retaining Wall (upland) ® Channel Modification ❑ Fishway JARPA 2009 Page 4 of 14 ❑ Other: JARPA 2009 Page 5 of 14 6d. Describe how you plan to construct each project element checked in 6c. Include specific construction methods and equipment to be used. hel • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year flood plain. The project will be completed during the summer months (August or September). In most years the stream channel is dry during this period. However, as excavation progresses upstream, it is possible that some groundwater will be experienced. The installation of a downstream rock check dam and surrounding silt fence per 2005 Stormwater Management Manual for Western Washington will ensure proper"best management practices" are maintained. With the erosion control measures implemented, the diversion dam will be excavated and the spoils will be used to fill the diversion channel. Stream sediment aggregations upstream of the diversion dam will be excavated down to the original stream elevation and slope. Clean excavated aggregate will be staged and utilized as substrate in the newly constructed stream channel. Excavation and channel construction will begin downstream working upstream. This excavation will be completed using "best management practices" outlined in the 2005 Stormwater Management Manual for Western Washington (please reference construction specifications for specific practices i.e. silt fence, check dam, etc.). All dam removal and channel reconstruction work will be located in the 100 year flood plain. Work will be completed by use of a typical modern excavator(i.e. CAT 325C). After the channel is constructed to its previous dimensions and slope, the channel will be lined with a mix of gravels and cobbles ranging in size from 1/ inch - 24 inches. Approximately 25% of the larger material will be angular rock to provide stability to the channel. Disturbed areas and constructed stream banks will be seeded and mulched. These areas will then be planted with site appropriate native woody plant species the following spring. 6e. What are the start and end dates for project construction? (month/year) h� elpl • If the project will be constructed in phases or stages, use DARPA Attachment D to list the start and end dates of each phase or stage. Start date: August 2009 End date: September 2009 ❑ See JARPA Attachment D 6f. Describe the purpose of the work and why you want or need to perform it. hel When the channel alignment of McTaggert Creek was altered many years ago it did not allow for fish passage. By the completion of the proposed creek restoration plan, fish passage will be regained and the natural flow of the creek returned. This project is to provide spawning and rearing habitat to steelhead, coho, and cutthroat trout in a mile section of stream. Diverted flows will also be returned to the channel. 6g. Fair market value of the project, including materials, labor, machine rentals, etc. hel $250,000 6h. Will any portion of the project receive federal funding? MM • If yes, list each agency providing funds. ❑ Yes ® No ❑ Don't know JARPA 2009 Page 6 of 14 Part 7—Wetlands: Impacts and Mitigation ❑ Check here if there are wetlands or wetland buffers on or adjacent to the project area. (If there are none, skip to Part 8.) 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. her r�l ❑ Not applicable 7b. Will the project impact wetlands? hel ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers? heg ❑ Yes ❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? hr m • If yes, submit the report, including data sheets,with the JARPA package. ❑ Yes ❑ No 7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating System? hr jpj • If yes, submit the wetland rating forms and figures with the JARPA package. ❑ Yes ❑ No ❑ Don't know 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? hel • If yes, submit the plan with the JARPA package. ❑ Yes ❑ No ❑ Not applicable 7g. Use the table below to list the type and rating of each wetland that will be impacted; the extent and duration of the impact; and the type and amount of compensatory mitigation proposed. If you are submitting a compensatory mitigation plan with a similar table, you may simply state (below) where we can find this information in the mitigation plan. hr elpl Activity causing Wetland type Impact area Duration Proposed Wetland impact (fill, and rating (sq. ft. or acres) of impact2 mitigation mitigation area drain, excavate, category' type (sq. ft. or acres) flood, etc.) Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System. Provide the wetland rating forms with the JARPA package. 2 Indicate the time(in months or years,as appropriate)the wetland will be measurably impacted by the activity. Enter"permanent" if applicable. 3 Creation(C), Re-establishment/Rehabilitation(R), Enhancement(E), Preservation(P), Mitigation Bank/In-lieu fee(B) Page number(s)for similar information in the mitigation plan, if available: 7h. For all filling activities identified in 7g., describe the source and nature of the fill material, the amount in cubic yards that will be used, and how and where it will be placed into the wetland. [help l 7i. For all excavating activities identified in 7g., describe the excavation method, type and amount of material in cubic yards you will remove, and where the material will be disposed. bpjpj 7j. Summarize what the compensatory mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. hr eM JARPA 2009 Page 7 of 14 Part 8—Waterbodies (other than wetlands): Impacts and Mitigation In Part 8, "waterbodies" refers to non-wetland waterbodies. (See Part 7 for information related to wetlands.) [hpjpi ® Check here if there are waterbodies on or adjacent to the project area. (If there are none, skip to Part 9.) 8a. Describe how the project is designed to avoid and minimize adverse impacts to the aquatic environment. hel ❑ Not applicable This is a creek restoration project that redirects water back to its original channel. The project will be started and completed within the dry seasonal months of(August or September): adjacent water bodies will not be affected. Potential groundwater that may surface will be contained via a downstream rock check dam and surrounding silt fence, ensuring proper"best management practices" are maintained. A strict erosion control plan has been compiled following the guidelines within the newest version of the Stormwater Management Manual for Western Washington. The project will improve the quality of McTaggert Creek, stabilizing its side slopes and allowing for fish passage. 8b. Will your project impact a waterbody or the area around a waterbody? [help] ® Yes ❑ No 8c. Summarize impact(s) to each waterbody in the table below. LheM Activity Waterbody Impact Duration Amount of Area (sq. ft. or causing impact name location' of material to be linear ft.) of (clear, dredge, impact2 placed in or waterbody fill, pile drive, removed from directly etc.) waterbody affected Excavation "original" Diversion dam 1 week 3,500 cubic yards McTaggert and continuing Creek 400' upstream channel Fill "diversion Parallel to 1 week 3,500 cubic yards channel" "original" McTaggert Mctaggert Creek Creek Indicate whether the impact will occur in or adjacent to the waterbody. If adjacent, provide the distance between the impact and the waterbody and indicate whether the impact will occur within the 100-year flood plain. z Indicate the time(in months or years,as appropriate)the waterbody will be measurably impacted by the work. Enter"permanent"if applicable. 8d. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? h[ eM • If yes, submit the plan with the JARPA package. ❑ Yes ❑ No ® Not applicable 8e. Summarize what the compensatory mitigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan. • If you already completed 7j.,you do not need to restate your answer here. hei N/A JARPA 2009 Page 9 of 14 8f. For all activities identified in 8c., describe the source and nature of the fill material, amount (in cubic yards) you will use, and how and where it will be placed into the waterbody. heI The "diversion channel" of McTaggert creek branches off the original channel. The original channel will be excavated (3,500 cubic yards) and the material reused to fill the adjacent "diversion channel" currently in-use (3,500 cubic yards).The fill material will be placed using a typical dump truck. Note that the"cut and fill" stage of this project will be completed during the dry season. The disturbed areas will be seeded and mulched. These areas will then be planted with site appropriate native woody plant species the following spring. 8g. For all excavating or dredging activities identified in 8c., describe the method for excavating or dredging, type and amount of material you will remove, and where the material will be disposed. [hel This is a creek restoration project, redirecting the flow back to its original channel of flow. The original channel will be excavated (3,500 cubic yards) and the material reused to fill the adjacent "diversion channel" currently in- use (3,500 cubic yards).The excavation will be done using a combination of a common land based excavator and dozer. Note that the"cut and fill" stage of this project will be completed during the dry season. The disturbed areas will be seeded and mulched. Part 9—Additional Information Any additional information you can provide helps the reviewer(s) understand your project. 9a. If you have already worked with any government agencies on this project, list them below. hel Agency Name Contact Name Phone Most Recent Date of Contact 9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 on the Washington Department of Ecology's 303(d) List? bpjpj • If yes, list the parameter(s)below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: http://www.ecy.wa.gov/programs/wq/303d/. ❑ Yes ® No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? h[ eM • Go to http://cfpub.epa.gov/surf/locate/index.cfm to help identify the HUC. Skokomish Watershed - 17110017 9d. What Water Resource Inventory Area Number(WRIA#) is the project in? hel • Go to http://www.ecy.wa.gov/services/gis/maps/wria/wria.htm to find the WRIA#. WRIA#16 (Skokomish/Dosewallips) JARPA 2009 Page 10 of 14 r 9e. Will the in water construction work comply with the State of Washington Ovate quality standards for turbidity? hf jpj • Go to http://www.ecy.wa.gov/programs/wg/swgs/criteria.htmi for the standards. ® Yes ❑ No ❑ Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? hf eM • If you don't know,contact the local planning department. • For more information,go to: http://www.ecy.wa.gov/programs/sea/sma/laws rules/173-26/211 desig nations.html. ❑ Rural ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other 9g. What is the Washington Department of Natural Resources Water Type? hel • Go to http://www.dnr.wa.gov/BusinessPermits/Topics/ForestPracticesApplications/Pages/fp watertyping.aspx for the Forest Practices Water Typing System. ❑ S ® F ❑ Np ❑ Ns 9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? hf eipl • If no, provide the name of the manual your project is designed to meet. ® Yes ❑ No Name of manual: Stormwater Management Manual for Western Washington 9i. If you know what the property was used for in the past, describe below. hei]I The property was designated to divert McTaggert Creek with the use of the present diversion dam. 9j. Has a cultural resource (archaeological) survey been performed on the project area? hel • If yes, attach it to your JARPA package. ❑ Yes ® No 9k. Name each species listed under the federal Endangered Species Act that occurs in the vicinity of the project area or might be affected by the proposed work. hel 91. Name each species or habitat on the Washington Department of Fish and Wildlife's Priority Habitats and Species List that might be affected by the proposed work. hf eM JARPA 2009 Page 11 of 14 Part 10—Identify the Permits You Are Applying For Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at http://apps.ecV.wa.gov/opas/. • Governor's Office of Regulatory Assistance at (800) 917-0043 or help a(bora.wa.gov. 10a. Compliance with the State Environmental Policy Act (SEPA). (Check all that apply.) hel • For more information about SEPA,go to www.ecy.wa.gov/programs/sea/sepa/e-review.htm1. ❑ A copy of the SEPA determination or letter of exemption is included with this application. ❑ A SEPA determination is pending with (lead agency). The expected decision date is ® I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 10b.) • Submit the Fish Habitat Enhancement Project form with this application. The form can be found at http://www.epermitting.wa.gov/Portals/ JarpaResoureeCenter/images/default/fishenhancement.doc ❑ This project is exempt (choose type of exemption below). ❑ Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? ❑ Other: ❑ SEPA is pre-empted by federal law. hel 10b. Indicate the permits you are applying for. (Check all that apply.) hel LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance ❑ Shoreline Exemption Type (explain): Other city/county permits: ❑ Floodplain Development Permit ❑ Critical Areas Ordinance STATE GOVERNMENT Washington Department of Fish and Wildlife: ® Hydraulic Project Approval (HPA) ® Fish Habitat Enhancement Exemption Washington Department of Ecology: ❑ Section 401 Water Quality Certification Washington Department of Natural Resources: ❑ Aquatic Resources Use Authorization FEDERAL GOVERNMENT United States Department of the Army permits (U.S. Army Corps of Engineers): ® Section 404 (discharges into waters of the U.S.) ❑ Section 10 (work in navigable waters) United States Coast Guard permits: ❑ General Bridge Act Permit ❑ Private Aids to Navigation (for non-bridge projects) JARPA 2009 Page 12 of 14 Part 11—Authorizing Signatures Signatures required before submitting the JARPA package. 11 a. Applicant Signature (required) [help] certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities, and I agree to start work only after I have received all necessary permits. I hereby authorize the agent named in Part 3 of this application to act on my behalf in matters related to this application. (initial) By initialing here, I state that I have the authority to grant access to the property. I also give my consent to the permitting agencies entering the property where the project is located to inspect the project site or any work related to the project. (initial) 1 2-9 101 Applicant Date 11 b. Authorized Agent Signature hel I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities and I agree to start work only after all necessary permits have been issued. Authorized Agent Date 11c. Property Owner Signature (if not applicant) hf eM I consent to the permitting agencies entering the property where the project is located to inspect the project site or any work. These inspections shall occur at reasonable times and, if practical, with prior notice to the landowner. Property Owner Date 18 U.S.0§1001 provides that:Whoever, in any manner within the jurisdiction of any department or agency of the United States knowingly falsifies,conceals, or covers up by any trick, scheme, or device a material fact or makes any false,fictitious, or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false,fictitious, or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than 5 years or both. If you require this document in another format, contact The Governor's Office of Regulatory Assistance(ORA). People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call(877)833-6341. 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