|
M�3Y-28-2019 11:02A FROM: T0:6517727977 P.3
<br /> , � APPLIGTION FOR DEPAR7M�NT QF THE ARMY PERMIT[�3 CFa 3� oMB APPROVAL NO.0710�003 Exnira Qa 31,2004 _
<br /> 7lw puWk 6urden for tlw eollee6on of u�bnnolwai u eo4rtuted to n�w.i.io na.n��eaa arnw�,me aaUony oro�r�;on.��a�iR�e�.�io...r,�.�oi�
<br /> Ih�tims fx rrviewine imm�Wian��hfiy etiuiiao drs�a�e�,p�Mwa�md wiiwa�ing d�e Ce�neeAed,end es�npMiing ad ieviewiy�he edleedea of inAea�wm.Sad
<br /> tonnne�d regudiag�hurdrn erim�ee xnny aharaeps�o�An aall«twn ef u�oa�wesen�on+Po��IuWag di�Mude�.ro Depmannu�fDafeme,wMin��eu
<br /> HeodqwMers Savin OMreoetin sFlwfarnreion Op�irsione d R�nti 121!Ja1RwK Aava Hiyhvny Snito 12b1.Arlingtou,VA 72103�302;u�d a da�Itfa nf Mwgament
<br /> md a�d8n.hvo,ralc aea�a�an r�c�ea to��a000�1.wa.n��w4 uc iosw. �u�ho�de eo aw.shn ne�wld�mmm�a.ro orw��o�a.onm.�,.a�s�ai ho
<br /> mbjat p qy peaelry!1r AWe/�o ca�fy wi�A a eolleuion of infannauon itil don nor d'u�ley i wcroa�ly wNd OA4B eo�hel nn�nbn. !'law DO NOT R6CURN yaur(bis a
<br /> alhr of Ihw eddnaa.CenplMtl�ppliwwro mup be�u4sta�d a tlr Ousiu engmeer hsvins�caateUon eraAu lemraa of dw woawed roiiriy.
<br /> �II IVACY ACI'STA'[BMBIVT;AuUwrllia.Rive�a�d Fle�hen Aq,�adan f 0,33 USC/00,CJea W�v Aa,Sepim/0/.7]USC!344;M�pa Pleualioe.Rne�eh aid
<br /> S�eoh�is Aa,b3 USC[�17.8em(oa 107 Priaapd�euposs�1nfa�Wn previded a�Ild�tane w1U M rrd ia ewlmtiy tM�ppliemfa Rr�pemd��wa:71d�
<br /> i�lbrmetioa nqy L��Mwd Mi8 dr Dapmva«r of Juotiee wd odier Falod.+uM.oud kal�rm�t ye+rJer.�nionea of��inlb�a�rien 4 valw�uy;how+rer,if
<br /> iafa�nlion i�fmt ot�LCA.the nrrm�f nml��im Ir erdod�xs�e�.i e�itl�iued.
<br /> lTEMS l THROUGIi 4 TO BE FILL�D IM BY THB COR'S
<br /> 1.APPLtCA770N NO. 2 F18LD OFFlCBCODfi 3.DATB REC61V13D 4 OATB APPI,ICMiON OOMPLETED
<br /> YOU DO NGT NEED TO CONIPLETH ITEM8 8-10 and 1Z-2a In the SHADED AREAS.
<br /> .tp applioonts muat¢amplebe aon�a6aded itema S ond 16. If�aga�l ia uied,Neo oomplete itenu 8 ond 11. 7bia optional Federol Form ia wlid
<br /> fbr uoe o when incl�sd u of thi�anli�e Nate licntion eoket.
<br /> s��`eti r �Q C,r �M,N�DY►��o,,r s�0{�� N�.1 f e�f'E.�' �����eyU�rea�
<br /> �� �� R AQEl�FT'S AAARGSS (�3 6✓C� �� � c � �
<br /> :,.., �.� ��/� M
<br /> •'?+� � y "�': .Id.AS3�NT'&PFi�NE A10. � r �°
<br /> I l.8TATBMIEIVT OR AU77IOR1ZATIOr1((lqppf/eaAh;eonsp/en oaly{ratuhor►zrrtg on ogenr)
<br /> I troeeby aWwriae w eat on nry 6ehalFes my o�eat ia the p�oeming of Ihie appliwfon and lo fumnh,upon requal,
<br /> � •upPl�rMntel Informalian in tuppat of IAI�p�eemil applicatiaa+.
<br /> APW.ICANT'S SI(fNA7VAE; DA7'6; �
<br /> 1� ���i(;1'�T'hl��t)R'17TI.&JwRiMhllC�ioN1 . , . . . ., . . . . . .. . .
<br /> :..:..,.e,.. .:, .. . :
<br /> •�19.NIINR�OI�WA7�(t�pC3Y;i'R KNOWN(if ap�ClcaMe) .M.1�J�CT S7Ri:BT AbDRESS�f tAppikaMe) .
<br /> �13:�.i�!'1��1�F.1!1�1�7' : ,.. • �� � .
<br /> >,�¢'�:�t�'#'l!�'.rv��Q�!�$kT�.J{IJQ�'1(14�C 1�.I�UCHop�) . . . .
<br /> �� , ..�. , • .
<br /> xT��� .�t1+1�"�4'�1��Nl'��:::��' .,te,�,�ri1Rn�rcr�v�[�►. � � � >. `
<br /> '... ':t:. •. . ., . W REA9QN(S}FURUISCHARfS� � . . .
<br /> ��:1�:�1.��'�L'l1il:�.. . . . .. .
<br /> ;�.1�.T��:�F.hlA,T,�tfAL�A1N(3 A[SA�JJ►JtARp AN,O"('ti8 AMUUNT OT EACH TYP@ IN q�p1G YARDS � • �
<br /> �`Y�:�U�Mi�l.�.r .���P Wg'I'IrAI!!!3&.QR Ol'HBR WATERS'!'1I:LI3A� ^ ' • - '
<br /> �.
<br /> �J�t;'ll �:L�'�1'_}�JpiNlNl},1'tWF�tlt'I''Y,01�l4�lHIjB� . . . � , � .. . . �+ •�•
<br /> ��•Y�i.� �����4'� ';��yR�'rj13���A71��7�hr'�8 t3R A!'rfiGYAl.91pL�Ah1.Q�lMlD PRdMt G1�18R I�i[1i!�AI.,ST�98l�RtAC�14+�GPNCi{�y!OR�' .
<br /> ;R� � .!P. 1{7 ���M�.n�. • . . ' •p.
<br /> 26. Application W heeeby�nade for o psnnit or pennits to�utl�orhe Ihe work desaibed in thig applieotion. I oeKify thu Ihe Infonnation in tfiie
<br /> appliaatlon ia completa and aca�rete. !Mther certify thnt l possw the authority lo underlobe lhe worlc described heroia or em actine as the duly
<br /> aulhorizcd u�em of tho�pliant
<br /> Q ,r/�.,�-�/�. � /-id
<br /> �p�Nwo of epplim� ��� D A c .g�au any onte
<br /> Thn oppliwtion mmtle signed by the paeon who detlra W uMeruke lhe proposed ec�iviry(apP�icant�a m m�y bs eip�ed by o duty aulhaitad e�t iF
<br /> Ih�qetmnait in Blook 1 I kas bcen RiNd out ad signod. 1�U.B.G&elbs 16i1 povidn�ihee:Whoevar,In�y mpnna wuMa the�urbdklbn�eny
<br /> daportment ar agency of tM UniNd 941a k�wwingly uid wifllWly Awifia.oonoal�,m oovsn up whh�qr Itick,seheme.a dtfeuMe!a eneterid l�et or
<br /> makes my bbe.fleddoua q Ik�ndulrll�hqmeMs or representetione or mebes m uw my ti�lme wriung or documaM knowing mme lo eon0oin my Ihlre,
<br /> fktkbm or Awdulenl�ulanaW or e�ury,tliell be fi�uA not mors dmn f IO,OOD or{mpriaoned aot naro thon five yan or bo11G
<br /> ENd FOttM 434l,1u197 EDITION OP FEB 941S OBSbLETE. (Proponent:CF.CW-0R)
<br /> Mimrcaolo LoesUSloWFedeeol ApplaMlon Fams Ibr Wa�edWedard Prqjam
<br /> �Z
<br />
|