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HomeMy WebLinkAboutJARPA FormPart 1 -Project Identification 1. PCOjeCt Name (A trams for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) � Point No Point Shellfish Farm in Dabob Bay Part 2—Applicant The person and/or organization responsible for the project. h[ eipj TM 1 016 11 X 2a. Name (Last, First, Middle) Allen, Ron & Sullivan, Jeremy APR 2 8 2017 2b. Organization (If applicable) JEFFE Jamestown S'Klallam Tribe and Port Gamble S'Klallam Tribe 2c. Mailing Address (Street or PO Box) 1033 Old Blyn Hwy - 2d. City, State, Zip Sequim, WA 98382 2e. Phone (1) 2f. Phone (2) 2g. Fax 2h. E-mail ( 360 )681-4630 ( 360 )460-3240 ( ) rriccio@jamestowntribe.org Part 3 -Authorized Agent or Contact 'Additional forms may be required for the following permits_ • It 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. • If your project might affect species llsled under the Endangered Species Act, you Will need to Till out a Specific Project Information Form (SPIE) or prepare a Biological Evaluation, Fortes can be found at hlfn.flvrww,nwsIM90.Army.—VIA.SlortslGtvilwoNts?R_eautatarwfP nnilGuidebookiEndanctred8necles,�, • Not all cities and counties accept the JARPA forthelr 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 WD'JIwwwaeuerrniljinr,_wa.govlsllaf{t(j s resoureecenterharoa Iaroa formMlHrjarimf rm.asax, For other help, contact the Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or hel _Qoriama. v. JARPA Revision 2015.1 Page 1 of 15 r--------------------------------------- CQJ ' AGENCY USE ONLY Date ' received: WASHINGTON STATE„• U9 A►my Corp+ ; 11 ; Joint Aquatic Resources Permit Agency reference #: Application (DARPA) Form1,2 Cq.lpjLease , #: 20 -Al 1121 & 20 -Al 128 USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. Tax Parcel #(s): `-_---___----------------------------' Part 1 -Project Identification 1. PCOjeCt Name (A trams for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) � Point No Point Shellfish Farm in Dabob Bay Part 2—Applicant The person and/or organization responsible for the project. h[ eipj TM 1 016 11 X 2a. Name (Last, First, Middle) Allen, Ron & Sullivan, Jeremy APR 2 8 2017 2b. Organization (If applicable) JEFFE Jamestown S'Klallam Tribe and Port Gamble S'Klallam Tribe 2c. Mailing Address (Street or PO Box) 1033 Old Blyn Hwy - 2d. City, State, Zip Sequim, WA 98382 2e. Phone (1) 2f. Phone (2) 2g. Fax 2h. E-mail ( 360 )681-4630 ( 360 )460-3240 ( ) rriccio@jamestowntribe.org Part 3 -Authorized Agent or Contact 'Additional forms may be required for the following permits_ • It 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. • If your project might affect species llsled under the Endangered Species Act, you Will need to Till out a Specific Project Information Form (SPIE) or prepare a Biological Evaluation, Fortes can be found at hlfn.flvrww,nwsIM90.Army.—VIA.SlortslGtvilwoNts?R_eautatarwfP nnilGuidebookiEndanctred8necles,�, • Not all cities and counties accept the JARPA forthelr 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 WD'JIwwwaeuerrniljinr,_wa.govlsllaf{t(j s resoureecenterharoa Iaroa formMlHrjarimf rm.asax, For other help, contact the Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or hel _Qoriama. v. JARPA Revision 2015.1 Page 1 of 15 Person authorized to represent the applicant about the project. (Note: Authorized agent(s) must sign 11 b of this application.) Gtj�_op] 3a. Name (Last, First, Middle) Riccio, Ralph, William 3b. Organization (If applicable) Jamestown S'Klallam Tribe 3c. Mailing Address (street or PO sox) 1033 Old Blyn Hwy 3d. City, State, Zip Sequim, WA 98382 3e. Phone (1) 3f. Phone (2) 3g. Fax ( 360 )681-4630 ( 360 )460-3240 ( ) Part 4—Property Owner(s) Contact Information for people or organizations owning the property(ies) where the project will occur. Consider both u land and aquatic ownership because the upland owners may not own the adjacent aquatic land. reel ❑ 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. ® 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) WA Department of Natural Resources 4b. Organization (If applicable) 4c. Mailing Address (Street or PO Box) 5310 Eaglemount Rd, 4d. City, State, Zip Chimacum, WA 98325 4e. Phone (1) 4f. Phone (2) 4g. Fax 4h. E-mail (360) 732-7411 ( ) ( ) sean.carlsonC.►,,,dnr.wa.1zov Part 5—Project Location(s) JARPA Revision 2015.1 Page 2 of 15 Identifying information about the property or properties where the project will occur. Ihe!pi ❑ There are multiple project locations (e.g. linear projects). Complete the section below and use JARPA Attachment B for each additional project location. r 5a. Indicate the type of ownership of the property. (Check all that apply.) nN€ ❑ 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. It there is no address, provide other location information in 5p.) Lfj�lpj East Dabob Bay 5c. City, State, Zip (If the project is not in a city or town, provide the name of the nearest city or town.) Ihe€Q) Quilcene, WA 5d. Countyhl al Jefferson T 5e. Provide the section, township, and range for the project location. t2211 1/4 Section Section Township Range 15-22 27N 1W 5f. Provide the latitude and longitude of the project location. taei Example: 47.03922 N lat. / -122.89142 W long. (Use decimal degrees - NAD 83) 47.8386N, -122.809W to 47.8222N, -122.7946W NAD83 5g. List the tax parcel number(s) for the project location. [bW • The local county assessor's office can provide this information, NA 5h. Contact information for all adjoining property owners. (it you need more space, use JARPA Attachment C.) (tom Name Mailing Address Tax Parcel # (if known) NA JARPA Revision 2015.1 Page 3 of 15 511. List all wetlands on or adjacent to the project location. {lei NA 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. ftW Dabob Bay 5k. Is any part of the project area within a 100 -year floodplain? iW Cl Yes ® No ❑ Don't know 51. Briefly describe the vegetation and habitat conditions on the property, � ei,l The project site is in the intertidal zone with some vegetation present. Eelgrass is located inside the parcels in some areas. The substrate is mostly sand and shell rubble from pre-existing oyster production. There are mature oysters with newer generations of oysters covering the substrate throughout the parcel. Manila clams are present as well. 5m. Describe how the property is currently used. fl eio The shellfish farm has not been in use since 2015. Several thousand mature oysters and manila clams are ready for harvest still remain on the property. 5n. Describe how the adjacent properties are currently used. a1 i The adjacent properties are currently used by the State and Tribes for commercial shellfish harvest. 50. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition.[bqipj NA 5p. Provide driving directions from the closest highway to the project location, and attach a map. RMW See Project Drawings JARPA Revision 2015 1 Page 4 of 15 Part 6—Project Description 6a. Briefly summarize the overall project. You can provide more detail in fib. hel Farm pacific oysters and manila clams in a variety of methods on 35 acres of the southern parcel for tribal harvest. Enhance oysters on 25 acres of the northern parcel with broad cast seeding of singles or seeded cultch for tribal harvest. Lease number: 20-A11121 & 20-A1128 6b. Describe the purpose of the project and why you want or need to perform it. hl eel � Purpose: Produce shellfish to sell for human consumption. The Tribes needs to grow shellfish because so many shellfish growing areas where the Tribes are accustomed to harvesting wild shellfish are either over harvested or are suffering from poor water quality. The Tribes must farm shellfish in order to exercise their treaty rights. The following farming methods will be used: On -Bottom Beach Oysters (Up to 25 acres) are oysters which are raised on tidal beaches with muddy, sandy or rocky bottoms. Seed oysters (<1 ") are distributed over the substrate and involves staking down a mesh predator net over the oysters to prevent the seed from being washed away or being consumed by predators. The net is removed when the oysters reach a larger size, within 90-120 days. Nets will not be used on more than two acres at any one time. Weather and UV exposure cause nets to degrade quicker, nets will not remain on the beach longer than necessary. Most of the on - bottom beach oysters will be growing freely on the substrate with no need for equipment. Oysters grow out for approximately 14 months, then are harvested by hand and placed into oyster harvest bags. Oyster harvest bags are containers that can be lifted onto a vessel like a crab pot. Surplus harvest will be brought to the deeper areas of the parcel void of Zostera marina, where it can be retrieved by vessel at high tide. This will reduce the number of low tides workers will be present on the beach between harvests. On -Bottom Flip Bags (Up to 25 acres) are used to grow oysters in mesh bags which are attached to a line and anchored to the substrate. Oysters will also grow out for either 14 months in the bags or be spread onto the beach after reaching a larger size. Suspended Tumbled Oyster Culture: (Up to 10 acres) Bag culture oysters are grown in mesh cages or bags which are generally staked about one to two feet off the bottom. This suspension method is usually done horizontally and staked about one to two feet above the bottom in an intertidal region. Tumbled oysters are raised in bags with floats on them and are periodically tumbled with normal tide exchange. This strengthens their shells and adds firmness to the meat. It also adds a distinctive look to the shell as it becomes smoother from tumbling. Manila Clam Farming Methods: (Up to 5 acres) Seeding of manila clams will take place throughout the property on any substrate at an elevation between one to six feet elevation. Seed will be spread on an incoming tide and will be covered with 15x50 foot predator netting. 6c. Indicate the project category. (Check all that apply)hj eM ® Commercial ❑ Residential ❑ Institutional ❑ Transportation ❑ Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements of your project. (Check all that apply) [help) ❑ Recreational JARPA Revlslon 2015.1 Page 5 of 15 Z Aquaculture ❑ Bank Stabilization ❑ Boat House ❑ Boat Launch ❑ Boat Lift ❑ Bridge ❑ Bulkhead ❑ Buoy ❑ Channel Modification ❑ Other: ❑ Culvert ❑ Dam / Weir ❑ Dike / Levee / Jetty ❑ Ditch ❑ Dock / Pier ❑ Dredging ❑ Fence ❑ Ferry Terminal ❑ Fishway ❑ Float ❑ Floating Home ❑ Geotechnical Survey ❑ Land Clearing ❑ Marina / Moorage ❑ Mining ❑ Outfall Structure ❑ Piling/Dolphin ❑ Raft ❑ Retaining Wall (upland) ❑ Road ❑ Scientific Measurement Device ❑ Stairs ❑ Stormwater facility ❑ Swimming Pool ❑ Utility Line JARPA Revision 2015.1 Page 6 of 15 fie. Describe how you plan to construct each project element checked in fid. 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 floodplain. All equipment described in section 6b. will be brought to the property by boat or via permitted land access and will be assembled by hand. 6f. What are the anticipated start and end dates for project construction? (MonthNear) IteiP.1 • If the project will be constructed in phases or stages, use JARPA Alfachment I7 to list the start and end dates of each phase or stage. Start date: April 1s' 2017 End date: On aoina ❑ See JARPA Attachment D 6g. l=air market value of the project, including materials, labor, machine rentals, etc. h i $20-30K 6h. Will any portion of the project receive federal funding? hili • 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.) lr, ip) 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. ❑ Not applicable 7b. Will the project impact wetlands? Iheinf I❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers? hW JARPA Revision 2015.1 Page 7 of 15 ❑ Yes ❑ No ❑ Don't know 7d. Hasa wetland delineation report been prepared? btigl ■ 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? het • 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? Ihei.pj • 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 ❑ Not applicable 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. Its] 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. ft*tj Activity (fill, drain, excavate, flood, etc.) Wetland Name' Wetland type and rating cate o s Impact area (sq. ft. or Acres) Duration of impact' Proposed mitigation type Wetland mitigation area (sq. ft. or acres •. o w . a, .supra a u1 i quo rias i w 1su6r i ab vx[irri IM a r. one name snoum ©a consistent wmn Omer project aacuments. $UCh as a wetland delineation report. a Ecology wetland category based on current western washfngion or Eastern Washington wetland Rating System. Provide the wetland rating forms with tyre JARPA package. 'Indicate the days, months or years the wetland will be measurably Impacted by the activity. tinter "permanent" It applicable. 'Creation (C), Re-establishment/Rehabllitallon (R), Enhancement (E), Preservallon (P), Mitigation Bankfin•lleu fee (B) Page number(s) for similar information in the mitigation plan, if available: A. For all filling activities identified in 7h, describe the source and nature of the fill material, the amount in cubic rds that will be used, and how and where it will be placed into the wetland. h[M__ _ JARPA Revision 2015.1 Page 8 of 15 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. help! 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.) ftw ® 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 Adverse impacts will not occur because we will be farming shellfish in areas that have been continually farme for over several years. Fallow areas with eelgrass will be avoided. Gear will be labeled and patrolling will happen twice a month to locate and remove derelict gear. 8b. Will your project impact a waterbody or the area around a waterbody? ei P ❑ Yes ® No As filter feeders, perhaps there will be a positive impact to water quality. JARPA Revision 2015.1 Page 9 of 15 80. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non -wetland waterbodies? LkM 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 ® Not applicable 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. hel NA 8e. Summarize impact(s) to each waterbody in the table below. h[ elM Activity (clear, dredge, fill, pile drive, etc.) Waterbody name' Impact location2 Duration of impact3 Amount of material (cubic yards) to be placed in or removed from waterbod Area (sq. ft. or linear ft.) of waterbody directly affected None ' If no official name for the waterbodv exists, create a unioue name (such as "Stream 1 ")Tha nam6 should nrnvirlaA z Indicate whether the impact wdI 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. 'Indicate the days, months or years the waterbody will be measurably im acled q Ilia work. Enter " ermanenl" if applicable 8f. For all activities identified in Be, 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. RMM M JARPA Revision 2015.1 Page 10 of 15 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. hei NA 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. [t) Agency Name J Contact Name &112-1 Army Corps Sean Carlson Pam Sangunetti Phone ( 360)732-7411 ( 206 )764-6904 Most Recent Date of Contact September 25th 2016 September 14th 2016 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? hei • If Yes, list the parameter(s) below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: bttp://www.acy-wa.goy&ro-qrams/wQ]3Q3cV. ❑ Yes ® No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) Is the project in? [r,wipj • Go to http:lJbtpub.epg.govlsut /iocaterndex.gfm to help identify the HUC. 17110018 9d. What Water Resource Inventory Area Number (WRIA #) is the project in? (W • Go to bU2.1/vaM.gcv,wa.aov/seake +yt`s1=§s griW& a.htm to find the WRIA #. 18 JARPA Revision 2015.1 Page 11 of 15 9e. Will the in -water construction work comply with the State of Washington water quality standards for turbidity? * Go to htW:/Avww.ecv,wa.gov/DroaramVMfswqstcdlerig.himiI rogramVMfswosfcdleria.html 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? Li,_eip1 • If you don't know, contact the local planning department. • For more information, go to: htto://www acv we govlor raMir *ell mallaws rullggl173-26121 t designations html. ❑ Rural ❑ Urban ❑ Natural ® Aquatic ❑ Conservancy ❑ Other 9g. What is the Washington Department of Natural Resources Water Type? 1hio _l • Go to hltp:/1ww%v-(f nr.wa. Loov/lorest•Rractices-water--$ ing 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? ihrJ • If No, provide the name of the manual your project is designed to meet. ® Yes ❑ No NA Name of manual: 9I. Does the project site have known contaminated sediment? EbAiA • If Yes, please describe below. ❑ Yes ® No 9j. If you know what the property was used for in the past, describe below. Ifs This property has been owned by Jerry Yamashita for many years and most recently it was subleased by National Shellfish Co.. The property was used for both oyster and clam aquaculture for many years. 9k. Has a cultural resource (archaeological) survey been performed on the project area? tel • M Yea, attach it to your DARPA package. ❑ Yes ® No Scheduled for November 16'h 2016 JARPA Revision 2015.1 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. LtiaW httpJAvww.nws.usace.army.rdtIPortals/27/docs/regulatory/l60907/USFWS_Final*/020BiOp_AM° 2020160826.pdf 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. ii, I� httpdtwww.nws.usace.army.mil/Portals/27/docs/regulatory/1609071USFWS_Finalc,,620BlOp AQOA2020160826.pdf Part 10—SEPA Compliance and Permits Use the resources and checklist below to identify the permits you are applying for. Online Project Ouestionnaire at http.L//apps.oria.wa.00v/opas/. Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or help@oria.wa.gov. For a list of addresses to send your JARPA to, click on ggency agencyaddresses for completed DARPA. 10a. Compliance with the State Environmental Policy Act (SEPA). (Check all that apply.) Wl • For more information about SEPA, go to www.ec .wa. oV/ r r sea/se al -r v' w ❑ 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.) ltlem ® This project is exempt (choose type of exemption below). ❑ Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? ® Other: Nationwide Permit 48 Pre-existing Shellfish A uaculture Farm ❑ SEPA is pre-empted by federal law. JARPA Revision 2015.1 Page 13 of 15 10b. Indicate the permits you are applying for. (Check all that apply.) (te J 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, Ex m tion Form You must submit a check for $150 to Washington Department of Fish and Wildlife, unless your project qualifies for an exemption or alternative payment method below. Do not send cash. Check the appropriate boxes: ❑ $150 check enclosed. Check # Attach check made payable to Washington Department of Fish and Wildlife. ® My project is exempt from the application fee. (Check appropriate exemption)_ ❑ HPA processing is conducted by applicant -funded WDFW staff. Agreement # ❑ Mineral prospecting and mining. ❑ Project occurs on farm and agricultural land. (Attach a copy of current land use classification recorded with the county auditor, or other proof of current land use.) Project is a modification of an existing HPA originally applied for, prior to July 10, 2012. HPA # 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 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) Other: United States Coast Guard permits: ❑ Private Aids to Navigation (for non -bridge projects) JARPA Revision 2015.1 Page 14 of 15 Part 11 -Authorizing Signature Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. tLelpj 11 a. Applicant Signature (required) hei 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 authori a agent named in Part 3 of this application to act on my behalf in matters related to this application. -'al) 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 enteri a property where the project is located to inspect the project site or any work related to the project, initial) Applicant P e Ap tica nat r Date 11 b. Authorized Agent Signature [hc!pj 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. Authorize Agent Printed Name Aut6bfized Agent Signature 11 c. Property Owner Signature (if not applicant) bgjpj Not required if project is on existing rights-of-way or easements, Date 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. See Attachment E 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) 833-8341. ORApublication number: ENV -019-09 rev. 0912015 JARPA Revision 2015.1 Paae 15 of 15 AGENC Y USIA ONLY _ US Army Gorps ! i of Englnoers i late receive(]: ; „J [ Q�Vn WASHINGTON STATE 5°°"wr "k` A pplication Fee Received; L Fee N/A F Joint Aquatic Resources Permit L-] New Application; r;=}Renewal Application Application (JARPA) [�, �-�a Type/Prefix #; ; NaturE Use Code: LNI ;Initials & BP#: RT Assets .Finance BP#: Attachment i :dew Application Number: 'i'rust(s):,.__..___..._-...... _.....____...__a County:Aquatic Use Authorization on AQR Plate #(s) Department of natural Resources Gori Lot#(s): Lease #: 20-A11121 & 20 - Al 128 (DNR)^managed aquatic lands [help] ± 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.Nwww.dnt-.wa.clov/progi,atns-and- seiviceslaguaticslleasinci-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://wa- dtirrs3.amazonaws.com/publications/agr land manager map 072415.pdf. [Help] • 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.) Lhpjp] DNR may reject the application at any time prior to issuing the applicant an Aquatic Use Authorization, heI 1. Applicant Name (hast, First, Middle) Allen, Ron and Sullivan, Jeremy 2. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) [help] Point No Point Shellfish Farms in Dabob Bay 3. Phone Number and Email 360 ...... ............_ �_...,.__.__..._.,..._�._._�. 681-4630 rriccloamest._..._......._................ ( ) @j owntribe.org 4. Which of the following applies to Applicant'? Check one and, if applicable, attach the written authority-- bylaws, power _ of attorney, etc. [i pA ❑ Corporation ❑ Individual Limited Partnership i ❑ Marital Community (Identify spouse): ❑ General Partnership ❑ Government Agency ❑ Limited Liability Company ® Other (Please Explain): Tribe Home State of Registration: JARPA Attachment E Revision 2015,2 Page 1 of 2 6. Washington UBI (Unified Business Identifier) number, if applicable: LRm 6. Are you aware of any existing or previously expired Aquatic Use Authorizations at the project location? ® Yes ❑ No Don't know W.. If Yes, Authorization number(s):20-A11121 and 20 -Al 1283 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, [help] NIA To be completed by DNR and a copy returned to theapiicant. 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. Printed Name Signature _� Dept. of Natural Resources Dept. of Natural Resources Date 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 (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 ENV -049-12 rev. 0912015 JARPA Attachment E Revision 2015.2 Page 2 of 2