HomeMy WebLinkAboutJARPA-Juvenile Steelhead Monitoring - SHX Application ---------------------------------------I
* M ' AGENCY USE ONLY
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WASHINGTON STATE ; Date received:
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Joint Aquatic Resources Permit
Agency reference#:
Application (DARPA) [he,,), Tax Parcel#(s):
,
Attachment A:
For additional property owner(s) [heI i TO BE COMPLETED BY APPL1CANTtpjpJ ,
Project Name: Hood Canal Steelhead
Project:Juvenile Monitoring ;
Use this attachment only if you have more than one property owner. Location Name(if applicable):Tahuya
Complete one attachment for each additional roe -----------------------------------------
impactedaccess to trap site '
P property rtY owner �
by the project.
Signatures of property owners are not needed for repair or maintenance activities on existing rights-of-way or
easements.
Use black or blue ink to enter answers in whites aces below.
1. Name(Last, First, Middle)and Organization (if applicable)
Rohde, Kirsten
2. Mailing Address(Street or PO Box)
2865 NE Tahuya River Rd
3. City, State, Zip
Tahuya, WA 98588-9684
4. Phone(1) 5. Phone(2) 6. Fax 7. E-mail
Address or tax parcel number of property you own:
322144300040
Signature of Property Owner
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.
Printed Name `^,flr5te(n R-01ave Signature
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-16-012 rev. 10/2016
JARPA Attachment A Rev.10/2016 Page 1 of 1