HomeMy WebLinkAboutSHX2023-00050 Taylor Shellfish Pickering Passage WA DNR JARPA - SHX Application - 12/5/2023 � i -----------AGENCY USE ONLY ------------�
US Army Corps Date received:
WASHINGTON STATE ofEnglneem. ;
Seattle District
Joint Aquatic Resources Permit ' Agency reference#:
Application (DARPA) Form'r2 h[ eM
USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. Tax Parcel#(s): ;
Part 1—Project Identification
1. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) [help]
Pickering Passage State WA DNR Lease 20-096483
Part 2—Applicant
The person and/or organization responsible for the project. h(�el ]
2a. Name (Last, First, Middle)
Taylor Shellfish Farms
2b. Organization (If applicable)
Taylor Shellfish Farms
2c. Mailing Address (Street or Po Box)
130 SE Lynch Rd
2d. City, State, Zip
Shelton, WA 98584
2e. Phone(1) 2f. Phone(2) :127g. Fax 2h. E-mail
360-426-6178 360-432-3348 ErinE@TaylorShellfish.com
lAdditional forms may be required for the following permits:
• If your project may qualify for Department of the Army authorization through a Regional General Permit(RGP),contact the U.S.Army Corps of
Engineers for application information(206)764-3495.
• Not all cities and counties accept the JARPA for their local Shoreline permits.If you need a Shoreline permit,contact the appropriate city or county
government to make sure they accept the JARPA.
2To access an online JARPA form with[help]screens,go to
http://www.epermitting.wa.gov/site/alias resourcecenter/jarpa iarpa form/9984/iarpa form.aspx.
For other help,contact the Governor's Office for Regulatory Innovation and Assistance at(800)917-0043 or helphelp _oria.wagov.
ORIA-revised 06/2023 Page 1 of 15
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.) [heip]
3a. Name (Last, First, Middle)
Ewald, Erin
3b. Organization (If applicable)
Taylor Shellfish Farms
3c. Mailing Address (street or Po Box)
130 SE Lynch Rd
3d. City, State, Zip
Shelton, WA 98584
3e. Phone(1) 3f. Phone(2) 3g. Fax 3h. E-mail
360-432-3348 360-426-6178 ErinE@TaylorShellfish.com
Part 4—Property Owner(s)
Contact information for people or organizations owning the property(ies) where the project will occur. Consider both
upland and aquatic ownership because the upland owners may not own the adjacent aquatic land. [help]
❑ 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 upland property owners. Complete the section below and fill out JARPA Attachment A for
each additional property owner.
Z Your project is on Department of Natural Resources (DNR)-managed aquatic lands. If you don't know, contact
the DNR at (360) 902-1100 to determine aquatic land ownership. If yes, complete JARPA Attachment E to
apply for the Aquatic Use Authorization.
4a. Name(Last, First,Middle)
State of Washington
4b. Organization (if applicable)
WA Dept. of Natural Resources
4c. Mailing Address(street or Po Box)
PO Box 47000
4d. City, State, Zip
Olympia, WA 98504
4e. Phone(1) 4f. Phone(2) 4g. Fax 4h. E-mail
360-902-1100
ORIA-revised 06/2023 Page 2 of 15
Part 5—Project Location(s)
Identifying information about the property or properties where the project will occur. fhelpi
❑ There are multiple project locations (e.g. linear projects). Complete the section below and use JARPA
Attachment B for each additional project location.
5a. Indicate the type of ownership of the property. (Check all that apply.) [help]
❑ Private
❑ Federal
❑ Publicly owned (state, county, city,special districts like schools, ports, etc.)
❑ Tribal
® Department of Natural Resources (DNR)— managed aquatic lands (Complete JARPA Attachment E)
5b. Street Address (Cannot be a PO Box. If there is no address,provide other location information in 5p.) [help]
Marine tidelands in Pickering Passage, near the town of Shelton
5c. City, State, Zip(If the project is not in a city or town,provide the name of the nearest city or town.) [help]
Shelton, WA
5d. County h[�el ]
Mason
5e. Provide the section, township, and range for the project location. el ]
'/4 Section Section Township Range
18 21 North 1 West, W.M.
5f. Provide the latitude and longitude of the project location. [Lei ]
• Example:47.03922 N lat./-122.89142 W long.(Use decimal degrees-NAD 83)
47.309936 / -122.853672
5g. List the tax parcel number(s)for the project location. [help]
• The local county assessor's office can provide this information.
State owned aquatic lands identified as 20-096483
5h. Contact information for all adjoining property owners. (if you need more space,use JARPA Attachment C.) h[ i ]
Name Mailing Address Tax Parcel #(if known)
Tyrone Rauschert 5830 SE Arcadia Rd
.................................................................... ----- — -...... 121181130010
Shelton, WA 98584
Lissak Family Trust 3297 S 3661h St 121181300012
Auburn, WA 98001
Michael & Linda Fish P.O. Box 220
.............. -............ -- .............................-.......--........................---- --. 121181300011
Grapeview, WA 98546
Mountain Shores Community 641 E Rauschert Rd 121185000041
Club, Inc Grapeview, WA 98546
ORIA-revised 0612023 Page 3 of 15
Marjorie Doremus 81 2"d St
................. _................................................. .. .................._..........__.__._..............__..................__..__........... 121181200000
Clifton, NJ 07011-3345
5i. List all wetlands on or adjacent to the project location. hf ela]
None
5j. List all waterbodies (other than wetlands) on or adjacent to the project location. [_heV]
Pickering Passage, Puget Sound
5k. Is any part of the project area within a 100-year floodplain? [help]
❑ Yes ❑ No ❑ Don't know X These are intertidal lands
51. Briefly describe the vegetation and habitat conditions on the property. [help]
The property is a sandy beach with minimal structure. There are no eelgrass or kelp beds mapped (WA DNR
seagrass mapping) or observed on this site, nor are there other priority habitat features. Uplands are low bank
on the other side of a state highway. Uplands are classified as rural residential.
5m. Describe how the property is currently used. [help]
The subject property is managed by the State of Washington aquatics program.
5n. Describe how the adjacent properties are currently used. hei ]
The tidelands to the north are privately owned and leased for commercial shellfish production. Other nearby
parcels support recreational shellfish farming and passive recreation including boating, fishing, and beach
combing. The surrounding uplands are used for single family residential.
I
5o. Describe the structures (above and below ground) on the property, including their purpose(s) and current
condition. [help]
There are no structures on the property.
5p. Provide driving directions from the closest highway to the project location, and attach a map. el ]
ORIA-revised 0612023 Page 4 of 15
Crews will access the farm by boat. Upland access would cross over private property.
Part 6-Project Description
6a. Briefly summarize the overall project. You can provide more detail in 6b. nei
This project is proposed for the commercial intertidal culture of geoduck clams. Hatchery raised juvenile
geoduck clams will be planted in the substrate by hand. Mesh HDPE tubes are inserted into the substrate and
planted by hand with geoduck seed. Tubes are removed after approximately 18-24 months. Cover net may or
may not be installed temporarily after tubes are removed if predation is observed. Nets are secured every 25'
with bent rebar inserted flush to the surrounding substrate. Harvest occurs after 5 — 7 years of planting.
6b. Describe the purpose of the project and why you want or need to perform it. [ham)
The purpose of this project is to cultivate shellfish seed to grow out for human consumption.
6c. Indicate the project category. (Check all that apply) [help]
® Commercial ❑ Residential ❑ Institutional ❑ Transportation ❑ Recreational
❑ Maintenance ❑ Environmental Enhancement
6d. Indicate the major elements of your project. (check all that apply) [help]
® Aquaculture ❑ Culvert ❑ Float ❑ Retaining Wall
❑ Bank Stabilization ❑ Dam /Weir ❑ Floating Home (upland)
❑ Boat House ❑ Dike / Levee / Jetty ❑ Geotechnical Survey ❑ Road
❑ Boat Launch ❑ Ditch ❑ Land Clearing ❑ Scientific
Measurement Device
❑ Boat Lift ❑ Dock/ Pier ❑ Marina / Moorage ❑ Stairs
❑ Bridge ❑ Dredging ❑ Mining ❑ Stormwater facility
❑ Bulkhead ❑ Fence ❑ Outfall Structure ❑ Swimming Pool
❑ Buoy ❑ Ferry Terminal ❑ Piling/Dolphin ❑ Utility Line
❑ Channel Modification ❑ Fishway ❑ Raft
❑ Other:
ORIA-revised 06/2023 Page 5 of 15
6e. Describe how you plan to construct each project element checked in 6d. Include specific construction
methods and equipment to be used. help]
• Identify where each element will occur in relation to the nearest waterbody.
• Indicate which activities are within the 100-year floodplain.
HDPE mesh nursery tubes, approximately 18", will be manually installed in the lower intertidal substrate at a
density of approximately 1 tube per 15" center. Four geoduck seed are planted in each tube. The tubes are
flexible and once inserted to a depth of approximately 9", can lay flat against the substrate. After
approximately 2 years, the tubes are removed. The area may be netted temporarily if predation is observed,
but then removed once it can be determined that the geoduck can evade predators. The beach is then left
undisturbed until harvest at 5 — 7 years after planting. The area is then replanted.
6f. What are the anticipated start and end dates for project construction? (Month/Year) Lep]
• If the project will be constructed in phases or stages, use JARPA Attachment D to list the start and end dates of each phase
or stage.
Start Date: Upon Permit End Date: On Going ❑ See JARPA Attachment D
6g. Fair market value of the project, including materials, labor, machine rentals, etc. [help]
Approximately $150,000
6h. Will any portion of the project receive federal funding? [help]
• If yes, list each agency providing funds.
❑ Yes ® No ❑ Don't know
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.) hLeip]
7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. heI ]
❑ Not applicable
7b. Will the project impact wetlands? [help]
❑ Yes ❑ No ❑ Don't know
7c. Will the project impact wetland buffers? [help]
❑ Yes ❑ No ❑ Don't know
ORIA-revised 06/2023 Page 6 of 15
7d. Has a wetland delineation report been prepared? h[�el I
• 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? Chi]
• 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? [help]
• If Yes, submit the plan with the JARPA package and answer 7g.
• If No, or Not applicable, explain below why a mitigation plan should not be required.
❑ Yes ❑ No ❑ Don't know
7 . Summarize what the mitigation Ian is meant t accomplish, n g g p o and describe how a watershed approach was ,
used to design the plan. [help]
it
I
i
i
7h. Use the table below to list the type and rating of each wetland impacted, the extent and duration of the
impact, and the type and amount of mitigation proposed. Or if you are submitting a mitigation plan with a
similar table, you can state (below) where we can find this information in the plan. [help]
Activity (fill, Wetland Wetland Impact Duration Proposed Wetland
drain, excavate, Name' type and area (sq. of impact3 mitigation mitigation area
flood, etc.) rating ft. or type (sq. ft. or
category 2 Acres) acres
'If no official name for the wetland exists,create a unique name(such as"Wetland 1"). The name should be consistent with other project documents,
such as a wetland delineation report.
2 Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System.Provide the wetland rating forms
with the JARPA package.
3Indicate the days,months or years the wetland will be measurably impacted by the activity.Enter"permanent"if applicable.
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:
ORIA-revised 06/2023 Page 7 of 15
71. For all filling activities identified in 7h, 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. [neipl
7j. For all excavating activities identified in 7h, describe the excavation method, type and amount of material in
cubic yards you will remove, and where the material will be disposed. [Lei ]
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.) [help]
❑ 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.
del
❑ Not applicable
This project is designed to avoid and minimize potential adverse impacts to the environment by complying
with all terms, conditions, and conservations associated with the programmatic consultation for shellfish
farming activities in Washington State inland marine waters between the Seattle District Corps of Engineers
and the National Marine Fisheries Service and the U.S. Fish and Wildlife Service. See Programmatic
Biological Assessment, Shellfish Activities in Washington State Inland Marine Waters, U.S. Army Corps of
Engineers Regulatory Program, October 2015; Programmatic Biological Opinion, National Marine Fisheries
Service, September 2016. Programmatic Biological Opinion for Shellfish Activities in Washington State Marine
Waters, U.S. Fish and Wildlife Service, August 2016.
Additionally, Taylor Shellfish employs Environmental Codes of Practice to ensure all activities meet
environmental standards. These measures include:
1. Routine mapping, or documentation of critical areas
2. Documentation of farm ECOP site visits
3. Employee training to ensure compliance of conservation measures
Finally, the cultivated shellfish at this farm are expected to provide important environmental benefits. The
cultivated shellfish and associated gear will provide three-dimensional structure, water quality enhancement,
eutrophication moderation, and facilitation of benthic-pelagic coupling of nutrients. Shellfish culture requires a
healthy marine ecosystem to be successful, and the farm will be operated and monitored to ensure the health
of the local ecosystem.
ORIA-revised 0612023 Page 8 of 15
8b. Will your project impact a waterbody or the area around a waterbody? hel
® Yes ❑ No Minimal and localized impacts may occur, including positive impacts.
8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland
waterbodies? [help]
• If Yes,submit the plan with the JARPA package and answer 8d.
• If No, or Not applicable,explain below why a mitigation plan should not be required.
❑ Yes ® No ❑ Don't know
This project is designed to avoid and minimize potential adverse impacts to the environment by complying
with all terms, conditions, and conservations associated with the programmatic consultation for shellfish
farming activities in Washington State inland marine waters between the Seattle District Corps of Engineers
and the National Marine Fisheries Service and the U.S. Fish and Wildlife Service. See Programmatic
Biological Assessment, Shellfish Activities in Washington State Inland Marine Waters, U.S. Army Corps of
Engineers Regulatory Program, October 2015; Programmatic Biological Opinion, National Marine Fisheries
Service, September 2016. Programmatic Biological Opinion for Shellfish Activities in Washington State Marine
Waters, U.S. Fish and Wildlife Service, August 2016.
8d. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was
used to design the plan.
• If you already completed 7g you do not need to restate your answer here. [hell ]
NA
8e. Summarize impact(s)to each waterbody in the table below. [Lei ]
Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or
dredge, fill, pile name' location of impact' (cubic yards) to be linear ft.) of
drive, etc.) placed in or removed waterbody
from waterbody directly affected
Minimal and Temporary
localized effects effects
from activities Pickering Marine during None Approx 1.9 acres
may occur. Passage tidelands short
Positive effects periods
may also occur.
If no official name for the waterbody exists,create a unique name(such as"Stream 1")The name should be consistent with other documents
provided.
2 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.
3Indicate the days,months or years the waterbody will be measurably impacted by the work. Enter"permanent"if applicable.
ORIA-revised 06/2023 Page 9 of 15
8f. For all activities identified in 8e, 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. [help]
NA
8g. For all excavating or dredging activities identified in 8e, describe the method for excavating or dredging,
type and amount of material you will remove, and where the material will be disposed. Lp]
NA
i
8h. Have you prepared a Water Quality Monitoring Plan (WQMP)for all in-water work (below ordinary high
water), over water work or discharges to waters of the state?
® Yes ❑ No
If NO describe the monitoring that you will be conducting including parameters, equipment and locations,
or explain why monitoring will not be necessary. [help]
Part 9-Additional Information
Any additional information you can provide helps the reviewer(s) understand your project. Complete as much of
this section as you can. It is ok if you cannot answer a question.
9a. If you have already worked with any government agencies on this project, list them below. [help]
ORIA-revised 06/2023 Page 10 of 15
Agency Name Contact Name Phone Most Recent
Date of Contact
WA DNR Kirsten Miller Kirsten.Miller@dnr.wa.gov 11/6/2023
U.S. Army Corps Kelsey Blubaugh Kelsey.N.Blubaugh@ October 2023
usace.army.mil
WA DOE Teressa Pucylowski tpuc461@ecy.wa.gov October 2023
9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 of this JARPA on the Washington
Department of Ecology's 303(d) List? [help]
• If Yes, list the parameter(s)below.
• If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: https://ecology.wa.gov/Water-
S horeli nes/W ater-gual ity/Water-im provement/Assessment-of-state-waters-303d.
® Yes ❑ No
DO, Fecal Coliform, Temp, pH
9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? [rielp]
• Go to https://water.usgs.gov/GIS/huc.htmi to help identify the HUC.
17110019
r
9d. What Water Resource Inventory Area Number (WRIA#) is the project in? Lop]
• Go to https://ecologv.wa.gov/Water-Shorelines/Water-supply/Water-availability/Watershed-look-up to find the WRIA#.
14
9e. Will the in-water construction work comply with the State of Washington water quality standards for
turbidity? [help]
• Go to https://ecology.wa.gov/Water-Shorelines[Water-quality/Freshwater/Surface-water-quality-standards/Criteria 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? [h_e�p]
• If you don't know, contact the local planning department.
• For more information, go to: https://ecology.wa.gov/Water-Shorelines/Shoreline-coastal-managementIShoreline-coastal-
planning/Shoreline-laws-rules-and-cases.
❑ Urban ❑ Natural ❑ Aquatic ® Conservancy ❑ Other:
9g. What is the Washington Department of Natural Resources Water Type? [help]
• Go to http://www.dnr.wa.gov/forest-practices-water-typing for the Forest Practices Water Typing System.
® Shoreline ❑ Fish ❑ Non-Fish Perennial ❑ Non-Fish Seasonal
9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater
manual? [help]
ORIA-revised 0612023 Page 11 of 15
• If No, provide the name of the manual your project is designed to meet.
❑ Yes ❑ No X NA
Name of manual:
9L Does the project site have known contaminated sediment? h[ eAi
• If Yes, please describe below.
❑ Yes ® No
9j. If you know what the property was used for in the past, describe below. Eel
The property has historically supported passive recreation and likely tribal fish and shellfish harvest.
9k. Has a cultural resource (archaeological) survey been performed on the project area? [help]
• If Yes, attach it to your JARPA package.
❑ Yes ® No
ORIA-revised 0612023 Page 12 of 15
91. 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
https://www.fisheries.noaa.gov/species-directory/threatened-endangered
Bocaccio
Chinook Salmon
Orca Whale
Steelhead Trout
Stellar Sea Lion
9m. 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. fwpi
http://apps.wdfw.wa.gov/phsontheweb/
Winter Steelhead
Residential Coastal Cutthroat Trout
Coho
Steelhead
Summer Chum
Part 10—SEPA Compliance and Permits
Use the resources and checklist below to identify the permits you are applying for.
• Online Project Questionnaire at http://apps.oria.wa.gov/opas/.
• Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or help(aD-oria.wa.gov.
• For a list of addresses to send your JARPA to, click on agency addresses for completed JARPA.
10a. Compliance with the State Environmental Policy Act (SEPA). (check all that apply.) [help]
• For more information about SEPA,go to https://ecology.wa.gov/requlations-permits/SEPA-environmental-review.
❑ A copy of the SEPA determination or letter of exemption is included with this application.
® A SEPA determination is pending with WADNR (lead agency). The expected decision date is
Spring 2024
❑ 1 am applying for a Fish Habitat Enhancement Exemption. (check the box below in 1ob.) heel ]
❑ 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.
ORIA-revised 06/2023 Page 13 of 15
101b. Indicate the permits you are applying for. (Check all that apply.) h(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 —Attach Exemption Form
Washington Department of Natural Resources:
® Aquatic Use Authorization
Complete JARPA Attachment E and submit a check for$25 payable to the Washington Department of Natural Resources.
Do not send cash.
Washington Department of Ecology:
® Section 401 Water Quality Certification
❑ Authorization to impact waters of the state, including wetlands (Check this box if the proposed impacts
are to waters not subject to the federal Clean Water Act
FEDERAL AND TRIBAL GOVERNMENT
United States Department of the Army (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:
For projects or bridges over waters of the United States, contact the U.S. Coast Guard at:
❑ Bridge Permit: D13-SMB-Dl3-BRIDGES@uscg.mil
❑ Private Aids to Navigation (or other non-bridge permits): D13-SMB-D13-PATON@uscg.mil
United States Environmental Protection Agency:
❑ Section 401 Water Quality Certification (discharges into waters of the U.S.) on tribal lands where tribes do
not have treatment as a state (TAS)
Tribal Permits: (Check with the tribe to see if there are other tribal permits, e.g.,Tribal Environmental Protection Act, Shoreline
Permits, Hydraulic Project Permits,or other in addition to CWA Section 401 WQC)
® Section 401 Water Quality Certification (discharges into waters of the U.S.) where the tribe has treatment
as a state (TAS).
ORIA-revised 06/2023 Page 14 of 15
Part 11-Authorizing Signatures
Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form,
project plans, photos, etc. h[Lel ]
11 a. Applicant Signature (required) hf eid
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 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 t e property where the project is located to inspect the project site or any work
related to the project. (initial)
E1 k •n CJLA c( ('1 3y�2oZ3
Applicant Printed Name A ure Date
11 b. Authorized Agent Signature fheipl
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.
�2v-_-
Authorized Agent Printed Name Aut onz ge ature Date
11 c. Property Owner Signature (if not applicant) fheipi
Not required if project is on existing rights-of-way or easements (provide copy of easement with JARPA).
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 Printed Name Property Owner Signature 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 $10,000 or imprisoned not more than 5 years or both.
If you require this document in another format, contact the Governor's Office for Regulatory Innovation and Assistance(ORIA)at(800)
917-0043. People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call(877)833-
6341. ORIA publication number: ORIA-16-011 rev. 09/2018
ORIA-revised 06/2023 Page 15 of 15
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Joint Aquatic Resources Permit ;7Q •`e1 Application; ❑ Renewal Application
Application (JARPA) mjfm Type/Prefix#:-,)Z;NaturE Use Code:Z$�
LNI initials& BP#:
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Trust(s): e2 ; County:
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Department of Natural Resources ; Go% Lot#(s): a
(DNR)-managed aquatic lands mw Tax Parcel#(s):
:---------------------------
Complete this attachment and submit it with the completed JARPA form only if you are applying for an Aquatic
Use Authorization with DNR. Call (360) 902-1100 or visit httP://www.dnr.wa.gov/programs-and-
services/aquatics/leasing-and-land-transactions for more information.
• DNR recommends you discuss your proposal with a DNR land manager before applying for
regulatory permits. Contact your regional land manager for more information on potential permit and
survey requirements. You can find your regional land manager by calling (360) 902-1100 or going to
http://www.dnr.wa.gov/programs-and-services/aquatics/ag uatic-d istricts-and-land-manaqers-map.
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• The applicant may not begin work on DNR-managed aquatic lands until DNR grants an Aquatic Use
Authorization.
• Include a $25 non-refundable application processing fee, payable to the "Washington Department of
Natural Resources." (Contact your Land Manager to determine if and when you are required to pay this
fee.) Mgai
DNR may reject the application at any time prior to issuing the applicant an Aquatic Use Authorization.
Use black or blue ink to enter answers in white spaces below.
1. Applicant Name (Last,First, Middle)
Taylor Shellfish Company
1 2. Protect Name (A name for your project that you create.Examples: Smith's Dock or Seabrook Lane Development)(help)
Rauschert State Lease
3. Phone Number and Email
(360)432-3340, DianeC@taylorshellfish.com
4. Which of the following applies to Applicant? Check one and.if applicable, attach the written authority—bylaws, power of
attorney, etc. V el
X Corporation 7 Individual
El Limited Partnership El Marital Community(Identify spouse):
n General Partnership
Limited Liability Company ❑ Government Agency
Home State of Registration: J Other (Please Explain):
JARPA Attachment E Rev. 1012016 Page 1 of 2
5. Washington UBI (Unified Business Identifier) number, if applicable: hei
91-17025787
6. Are you aware of any existing or previously expired Aquatic Use Authorizations at the project location?
® Yes 0 No ❑ Don't know
If Yes, Authorization number(s): 23-086298 Right of Entry Agreement
7. Do you intend to sublease the property to someone else?
❑ Yes ® No
If Yes, contact your Land Manager to discuss subleasing.
8. If fill material was used previously on DNR-managed aquatic lands, describe below the type of fill material
and the purpose for using it. h( elpa
NA
To be completed by DNR and a copy returned to the applicant.
Signature for projects on DNR-managed aquatic lands:
Applicant must obtain the signature of DNR Aquatics District Manager OR Assistant Division Manager if the
project is located on DNR-managed aquatic lands.
I, a designated representative of the Dept. of Natural Resources, am aware that the project is being proposed on
Dept. of Natural Resources-managed aquatic lands and agree that the applicant or his/her representative may
pursue the necessary regulatory permits. My signature does not authorize the use of DNR-managed aquatic
lands for this project.
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Printed Name Signature Date
Dept.of Natural Resources Dept.of Natural Resources
District Manager or Assistant Division Manager District Manager or Assistant Division Manager
If you require this document in another format, contact the Governor's Office for Regulatory Innovation and
Assistance (OR1A) at (800)917-0043. People with hearing loss can call 711 for Washington Relay Service.
People with a s ech disability can call 877 833-6341. ORIA Publication ORIA-16-016 rev. 10/2016
JARPA Attachment E Rev. 1012016 Page 2 of 2