HomeMy WebLinkAboutCZM_form_(Federal_Permit_License)CERTIFICATION OF CONSISTENCY WITH
THE WASHINGTON STATE COASTAL ZONE MANAGEMENT PROGRAM
FOR FEDERALLY LICENSED OR PERMITTED ACTIVITIES
Federal Application Number: _____________________
Applicant: _________________________________
Project Description: __________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
(attach site plans, location (county/city), and proximity to waterbody (name))
This action under CZMA§307(c)(3) is for a project that will take place within Washington’s coastal zone
or which will affect a land use, water use, or natural resource of the coastal zone. (The coastal zone
includes all parts of Clallam, Grays Harbor, Island, Jefferson, King, Kitsap, Mason, Pacific, Pierce, San
Juan, Skagit, Snohomish, Thurston, Wahkiakum, and Whatcom counties.)
The project complies with the following enforceable policies of the Coastal Zone Management Program:
1. Shoreline Management Act (SMA):
Is outside of SMA jurisdiction ( )
Applied for shoreline permit ( )#____________being reviewed by _______________
Has a valid shoreline permit ( )#____________issued by______________on_______
Has received an SMA Exemption ( )#____________issued by______________on_______
2. State Water Quality Requirements:
Does not require water quality permits ( )
Applied for water quality certification ( )
Has received water quality certification ( )# _________________issued on ______________
Applied for stormwater permit ( )# _________________on ______________
Has received stormwater permit ( )# _________________issued on _______________
3. State Air Quality Requirements:
Does not require air quality permits ( )
Applied for Air Quality permit ( )#______________being reviewed by _____________
Has an Air Quality permit ( )# _____________issued by ___________on _______
4. State Environmental Policy Act: SEPA Lead Agency is: _________________________
Project is exempt from SEPA ( )
SEPA checklist submitted ( ) date_____________
SEPA decision issued/adopted ( )DNS ( ) MDNS ( ) EIS ( ) Other _______ date ______
NEPA decision adopted by ( )SEPA # _________________ date ________
lead agency to satisfy SEPA
Public Notice for this proposed project was provided through:
( ) notices mailed to interested parties using _____________________mailing list on _________(date).
( ) publication in ___________________________ (newspaper) on _______________________(dates).
( ) other (include dates) ______________________________________________________________
Therefore, I certify that this project complies with the enforceable policies of Washington’s approved
Coastal Zone Management Program and will be conducted in a manner consistent with that program.
Signature: Date: