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Home My WebLink AboutSDP2017-00007 JARPAM I. 00F US Army Corps WASHINGTON STATE o1lEnpinee;s Joint Aquatic Resources Permit Application (DARPA) Form 1'2 USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. Part 1 -Project Identification t•—' ---- ------ ---------I AGENCY USE ONLY � I Date received: 4 I � 1 V I F I 1 I Agency reference #: A I Tax Parcel #(s): ; F i ---------------------------- + e r _ 1 1 1 + r a r 1 f 1 t 1. Project Name (A name for your project that you create. Examples: Smith's Dock or Barden Living Trust Bulkhead Repair and Installation Part 2 -Applicant The person and/or organization responsible for the project.Irl elp] JEFFERSON COUNTY DCD 2a. Name (Last, First, Middle) Barden Living Trust and Sherri Barden Hunter, Trustee 2b. Organization (If applicable) 2c. Mailing Address (Street or PO Box) 240 Maple Lane 2d. City, State, Zip Port Ludlow, WA 98365 2e. Phone (1) 2f. Phone (2) 2g. Fax 2h. E-mail kevinhunter@aol.com & sherrihunter@outlook.com (360) 821-9684 Part 3 -Authorized Agent or Contact Additional 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 • If your project might affect species listed under the Endangered Species Act, you will need to fill out a Specific Project Information Form (SPIF) or prepare a Biological Evaluation. Forms can be found at h ttp://Www. nws.usace _army . m i i/M issi o n slC i vilworkslRegulatoryiPermi tGu idebook (Endangered Sgecies.a sgx . • 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. 2 T access an online JARPA form with [help] screens, go to http.Ilwww.agerrriittinsa.wa_.govlsitelalias_ resoureae�nterl a a jarksa form199841iarga form.asgx. For other help, contact the Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or heip[d3ara.wa.gov. JARPA Revision 2012.2 Page 1 of 14 Person authorized to represent the applicant about the project. (Note: Authorized agent(s) must sign 11 b of this application.) [ham] 3a. Name (Last, First, Middle) Laleggio, James 3b. Organization (If applicable) Marine Surveys & Assessments 3c. Mailing Address (Street or PO Box) 267 Hudson St. 3d. City, State, Zip Port Townsend, WA 98368 3e. Phone (1) 3f. Phone (2) 3g. Fax 3h. E-mail (360) 385-4073 l Jameslaleggio.msa@gmail.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. Iltie ipl ® 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. Part 5 -Project Location(s) Identifying information about the property or properties where the project will occur. pieipl JARPA Revision 2012.2 Page 2 of 14 ❑ 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] 240 Maple Lane 5c. City, State, Zip (If the project is not in a city or town, provide the name of the nearest city or town.) het Port Ludlow, WA 98365 5d. County [help] Jefferson 5e. Provide the section, township, and range for the project location. [help] '/4 Section Section Township I Range SW 04 28N WE 5f. Provide the latitude and longitude of the project location. [help • Example: 47.03922 N lat. / -122.89142 W long. (Use decimal degrees - NAD 83) North bulkhead: 47056.591'N/ -122'41.105'W and South bluff: 47'56.566'N/ -122041.108' W 5g. List the tax parcel number(s) for the project location. [help] • The local county assessor's office can provide this information. 976500002 &13 5h. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment C.)h[ ell j Name Mailing Address Tax Parcel # (if known) Jack & Carol Allen 191 Maple Lane (Port Ludlow, WA 98365 '978900110 Neil Lamka 250 Maple Lane 'Port Ludlow, WA 98365 978900038 Richard Ostlund Trste Vollea Ostlund Trste Michael Larkin PO Box 65136 976500003 Port Ludlow, WA 98365 5i. List all wetlands on or adjacent to the project location. [helpl JARPA Revision 2012.2 Page 3 of 14 Does not apply. 5j. List all waterbodies (other than wetlands) on or adjacent to the project location.hf M Admiralty Inlet 5k. Is any part of the project area within a 100 -year floodplain?h[ qu X Yes ❑ No ❑ Don't know FEMA FIRMS (Flood Maps) Type A on Jefferson County Layer 51. Briefly describe the vegetation and habitat conditions on the property.h[ eV The critical area between the house and the bluff is vegetated mostly with grass and ornamental shrubs. 5m. Describe how the property is currently used.h[�] The property is used as a single-family residence with beach access. 5n. Describe how the adjacent properties are currently used. h[ elal To the north of subject property lies an undeveloped Jefferson County Right of Way (Maple Lane). Properties to the north of Maple Lane and properties to the south of subject property are single-family residences. 50. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition.hf eM Structures on parcel numbers 976500002 and 976500013 include a 2,741 sq. ft. home that was built in 2006 and an 880 sq. ft. cabin that was built in 1962. Stairs descend from the upland to the beach near the northern end of the site. There is an existing rock bulkhead that was built more than 50 years ago. 5p. Provide driving directions from the closest highway to the project location, and attach a map.hf eV From Port Townsend, take WA -20 W and merge onto WA -19 S. In 3.4 mi turn left onto WA -116. In 2 miles continue onto Oak Bay Rd. In 6.7 mi turn left onto Maple Lane. Destination will be on the right. Part 6 -Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. MM Bulkhead repair in same footprint and extension. 6b. Describe the purpose of the project and why you want or need to perform it. [h@M JARPA Revision 2012.2 Page 4 of 14 The purpose of this project is to repair an existing rockery bulkhead that was damaged during an exceptionally high tide and storm in February of 2016. The existing residence relies on this bulkhead for protection from shoreline processes. Presently, the foundation is within 20 feet of the top of the bluff, and the decks are within 14 feet. The portion of the bulkhead to be repaired is approximately 113 feet in length. The bulkhead was built prior to 1971 and prior to shoreline regulations that govern shoreline armoring (See Attachment 1). Therefor, the project falls under County Code Shoreline Exemption 18.25.560, exemption 2: "Maintenance and Repair". A new section of bulkhead is proposed that will extend 45 feet to the south of the existing bulkhead in order to provide full protection to the single family residence and will be in compliance with JCC 18.25.410 (5) and (6). 6c. Indicate the project category. (Check all that apply)hf e 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 El Stairs ❑ Bridge ❑ Dredging ❑ Mining ' ❑ Stormwater facility ® Bulkhead ❑ Fence ❑ Outfall Structure ❑ Swimming Pool ❑ Buoy ❑ Ferry Terminal ❑ Piling/Dolphin E] Utility Line ❑ Channel Modification ElFishway F-1Raft ❑ Other: JARPA Revision 2012 2 Page 5 of 14 6e. Describe how you plan to construct each project element checked in 6d. Include specific construction methods and equipment to be used.hf eN • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100 -year floodplain. The proposed construction sequence will involve: establishing temporary access in the County right of way (machinery to be walked over existing rock to beach, next to concrete boat ramp), removing existing bulkhead (113 feet) and adding 45 feet of new bulkhead to the south end of existing bulkhead. The process includes: excavating keyway, installing rockery bulkhead armor rocks, installing filter fabric, placing spalls backfill and removing the temporary site access from the County right of way once construction is completed. All rock shall conform to requirements set out in Arc Construction Guideline (2013) Section 2.01.1 Rock Quality. Rock size shall be between one man and three man. Larger rocks shall be placed at the bottom and smaller rocks shall be placed at the top. Existing rocks may be incorporated into the repair, provided that they conform to the specifications. The area between the bulkhead and existing bank shall be filled with clean angular 4 -inch to 6 -inch spalls. Filter fabric shall be non -woven and conform to recommendations made in the Arc Rockery Construction Guidelines (2013). The bottom row of rocks shall be placed in a keyway at least three feet below the natural beach elevation. The keyway subgrade shall be inclined slightly towards the existing bank to the west. Bulkhead rocks shall be placed in a manner where any one rock does not rest on one single rock of the layer below. The face of the rockery bulkhead shall be inclined at a batter of 1 H: 4V. Filter fabric shall extend from the top of the existing bank and down over the existing soils and then between the backfill and the rockery bulkhead. Thickness of the backfill between the rockery bulkhead and the existing bank shall be a minimum of 12 inches. Spalls shall be placed at a slope of 1.5H: 1V to 2H: 1V from the back of the rockery bulkhead to the existing bank. 6f. What are the anticipated start and end dates for project construction? (MonthNear)h[ e • 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: July 2017 End date: August 2017 ❑ See JARPA Attachment D 6g. Fair market value of the project, including materials, labor, machine rentals, etc.hj ela] $38,967.50 6h. Will any portion of the project receive federal funding? h[ elp] • 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.)h[ eM 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. [hell ] ® Not applicable JARPA Revision 2012.2 Page 6 of 14 Move to Part 8 71b. Will the project impact wetlands?hf eM ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers?h[�] ❑ Yes ❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? MM • 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?hf elal • 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 ❑ Not applicable 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. mu 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. h[ elp] Activity (fill, drain, excavate, flood, etc.) Wetland Name' Wetland type and rating category2 Impact area (sq. ft. or Acres) Duration of impact3 Proposed mitigation type Wetland mitigation area (sq. ft. or acres) JARPA Revision 2012.2 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.)h[ eV ® 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. [help] ❑ Not applicable JARPA Revision 2012.2 Page 8 of 14 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. ' Indicate the days, months or years the wetland will be measurably impacted by the activity. Enter "permanent' if applicable. 4 Creation (C), Re-establishment/Rehabilitation (R), Enhancement (E), Preservation (P), Mitigation Banklln-lieu fee (B) Page number(s) for similar information in the mitigation plan, if available: 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. [Help] 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. Lop 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.)h[ eV ® 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. [help] ❑ Not applicable JARPA Revision 2012.2 Page 8 of 14 Best Management Practices will be followed to reduce the potential for erosion of exposed soil and to limit sediment generation. Storm water outfalls that discharge to the bulkhead or shoreline in work area will be protected and/or replaced. Affected offsite streets will be kept clean at all times. Silt fences will be installed prior to work. Spoils and soil stockpiles will be covered as much as possible during wet weather. Streets used as access will be cleaned of soils each day. Permanent erosion control of exposed soils below the bulkhead shall consist of regarding. Permanent erosion control of County right of way shall consist of hydro seed. An erosion mix shall be used meeting the requirements of section 9-14,4(2) of the 2016 WSDOT standard specifications. Non-native soils removed during bulkhead construction shall be immediately removed from the beach to a stockpile location. Non-native soils shall not be stockpiled on the beach at any time. Native beach soils shall remain on the beach. At the end of each day the beach shall be temporarily smoothed and recontoured to the natural condition. 8b. Will your project impact a waterbody or the area around a waterbody? hf @M ® Yes ❑ No 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non -wetland waterbodies?hf eM • 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 A native planting plan has been designed and can be found within the Habitat Assessment. 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.h[ w The native planting plan was designed with the intent to improve the overall value of the functions in this critical area buffer. Soil stability at the top of the bluff was the most important focus of this planting plan but nutrient input and wildlife habitat were important factors as well. Plants are proposed on sections of the bluff above the existing bulkhead as well as a riparian buffer along the top of the bluff where there will be no bulkhead. 8e. Summarize impact(s) to each waterbody in the table below. MM Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or dredge, fill, pile name location of impact3 (cubic yards) to be linear ft.) of drive, etc.) placed in or waterbody removed from directly affected waterbody Bulkhead repair Admiralty At or near Approx.Nothing to be placed Approx. 1 linear and installation. Inlet OHWM one week. in water. feet at/above the OHWM. 1 JARPA Revision 2012.2 Page 9 of 14 If no official name for the waterbody exists, create a unique name (such as "Stream 1 ") The name should be consistent with Other doc=ents provided. 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. 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, Nothing will be placed in the water body. The toe of the existing bulkhead is at the OHWM. While repairs are under way, equipment will be on the beach below the OHWM (during low tides), as work cannot be performed from the top of bank. No fill will be on beach below the OHWM. Materials taken from existing bulkhead will be temporarily stock piled on the uplands (Barden Living Trust property — see site plan) and taken back when new rocks are placed. 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. help} Does not apply — nothing to be placed in, or removed from the adjacent waterbody. 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.[kV Agency Name Contact Name Phone Most Recent Date of Contact Jefferson County Emma Bolin (360) 379-4450 June 13, 2017 WDFW Margie Bigelow December 9, 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? [heip] • If Yes, list the parameter(s) below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: http:llwww.ecy.wa.gov/prograrns/wq/303d1. Yes X No JARPA Revision 2012.2 Page 10 of 14 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in?(Lou • Go to htti):l/cfpub.epa.gov/surf/locate/index.dm to help identify the HUC. 17110018 9d. What Water Resource Inventory Area Number (WRIA #) is the project in? tLeslj • Go to hhp:/lwww.ecy.wa.govfservices/gislmapslwria/wria.htm to find the WRIA #. WRIA 17 (Quilcene-Snow) 9e. Will the in -water construction work comply with the State of Washington water quality standards for turbidity?elelp • Go to http;llwww.ecy.wa.gov1pradramslwglswgslcriteria.html for the standards. ❑ Yes ❑ No X Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? [heipj • If you don't know, contact the local planning department. • For more information, go to: http:llwww.ecy.wa.ggvlpfograms/sea/sma/laws_ruies/173-261211 designations.html. ❑ Rural ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy X Shoreline Residential Other Priority A uatic 9g. What is the Washington Department of Natural Resources Water Type? he -IPJ • Go to ht!p: Nw.d n r.wa.govIBus inessPe rm itsITopics/ForestPracticesApplications/Pafiestfp—waterty ping. as for the Forest Practices Water Typing System. X 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] • If No, provide the name of the manual your project is designed to meet. ❑ Yes ❑ No X Does not Apply Name of manual: 91. Does the project site have known contaminated sediment? [help] • If Yes, please describe below. ❑ Yes X No 9j. If you know what the property was used for in the past, describe below. [help] Single family residence. 9k. Has a cultural resource (archaeological) survey been performed on the project area? (help) • If Yes, attach it to your JARPA package. JARPA Revision 2012.2 Page 11 of 14 ❑ Yes No X Unknown 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. [helpl The US Fish and Wildlife Service designates the site area as designated critical habitat for listed Bull Trout (Salvelinus confluentus). However, as proposed work will be conducted from land during low -tide windows, no impact is expected and therefore no survey is recommended. 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. h[ elpl A query to the Washington Department of Fish and Wildlife Priority Habitat and Species (PHS) mapper indicated that the site has been mapped as breeding habitat for Surf Smelt (Hypomesus pretiosus) and Sand Lance (Ammedytes hexapterus) have been documented to the north and south. There are work windows for these species, which depending on the time of construction, might necessitate a forage fish survey to ensure no negative impact ensues. 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.egy.wa.lc ovfopas/. • Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or help(aD-ora.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.) fbem • For more information about SEPA, go to www.ecy.wa.covlgrograms/sea/sepa/e-review.html. ❑ A copy of the SEPA determination or letter of exemption is included with this application. A SEPA determination is pending with Jefferson County (lead agency). The expected decision date is Spring/Summer 2017. ❑ I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 10b.) [helpl ❑ 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. 10b. Indicate the permits you are applying for. (Check all that apply.) heelpj LOCAL GOVERNMENT JARPA Revision 2012.2 Page 12 of 14 Local Government Shoreline permits: Substantial Development ® Conditional Use ❑ Variance ® Shoreline Exemption Type (explain): Repair and maintenance. 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 — Aii001 C_xomption Fowl http: //www.nws.usace. army.miUPublicMenu/Menu.cfm?sitename=REG&pagename=Home_Page Effective July 10, 2012, 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.: Will be paid through the Apps Program. ❑ $150 check enclosed. Check ## Attach check made payable to Washington Department of Fish and Wildlife. J,] My project is exempt from the application fee. (Check appropriate exemption) ❑ HPA processing is conducted by applicant -funded WDFW staff. Agreement # F] 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 DARPA 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) United States Coast Guard permits: ❑ Private Aids to Navigation (for non -bridge projects) JARPA Revision 2012.2 Page 13 of 14 Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. [I,eip] 11 a. Applicant Signature (required) Iiicipj 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 the property where the project is located to inspect the project site or any work related to the project. (initial) Applicant Printed Name Applicant Signature Date 11 b. Authorized Agent Signature [help] 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. Marine Surveys & Assessments Authorized Agent Printed Name Authorized Agent Signature Date 11 c. Property Owner Signature (if not applicant) [help] Not required if project is on existing rights-of-way or easements. 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: ENV -019-09 rev. 08/2013 JARPA Revision 2012.2 Page 14 of 14 Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc.h[ elp] 11 a. Applicant Signature (required) 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 I have received all necessary permits. I hereby aull ,agent named in Part 3 of this application to act on my behalf in matters related to this applicatio (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 enter property where the project is located to inspect the project site or any work related to the project. (initial) Applicant Printed Name Applicant Signature__ Date ./ ��r ,AA4 11 b. Authorized Agent Signatureh(_elpi 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. Marine Surveys & Assessments Authorized Agent Printed Name Authorized Agent Signature Date 11 C. Property Owner Signature (if not applicant) hel Not required if project is on existing rights-of-way or easements. 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. ENV -019-09 rev. 0812013 JARPA Revision 2012.2 Page 14 of 14 _ _ r __ _ __ _ _ _ _ - - _ _ _ __ -- � c __ � _ _ - r - r - - - -- - _ - r _ _ _ - -- -r - -- _ -- _ _ -- ��` - -� - ��` - - �~ - - --,r - - sr _ _ -- - r _ _ - -~ _ _ __ _ _ r __ _ __ _ _ _ _ - - _ _ _ __ r -- c - sr c - -_ -- � _ _�� - - _ -�` �� - - -- _ _ _