The Applicant must have real property interest over the land upon which the activities subject to this notice will be conducted. An applicant may be the property owner, the holder of a recorded easement, a buyer with a contract to purchase or an entity that possesses other equitable property interest that allows for modifications to the land and authorizes the Agency staff or its agents to access and inspect the property. Documentation that explains the type of property interest must be included with this application.

If a representative is submitting this notice on behalf of the Applicant, the Owner/Applicant Authorization form, which is located at the end of this notice (see Section 5), must be signed by the Applicant listed above.

¹ If only nuisance vegetation removal is proposed, refer to the EPC’s List of Nuisance Plants to determine if WNV 15-Application for Nuisance Vegetation Removal is appropriate (no fee).

Docks or boardwalks:

• Approximate wetland line
• Dimensions of proposed length of structure
• Depict and label the approximate Ordinary High Water (OHW)/High Guidance Level (HGL), Low Guidance Level (LGL), and associated depths. Please check the water atlas for water level information.
• Height of structure above wetland substrate/ground level. Please be advised, a minimum of 3.5’ elevation is required.
• Height of the structure above OHW/HGL. Please be advised, a minimum of 1’ elevation is required.
• Depth in mooring areas at LGL. Please be advised, a minimum of 2’ of depth is required.
• Any structures to be erected upon it (i.e., roof, railings, etc.)

Rip Rap:

• Approximate wetland line/existing embankment (top of bank)
• Materials and average size. Please be advised, shall not be less than 1’ in diameter.
• Filter fabric liner under rip rap
• Slope, height, length out. Please be advised, shall not be steeper than 2:1
• Method of placement. Please be advised, hand placement is required around native trees.

If new rip rap, please provide documentation of on-going erosion. This can be supported with photos, historic aerials, and/or a narrative describing site conditions.

Boat Ramps:

• Approximate wetland line
• Length of ramp landward and waterward of OHW/HGL and wetland line
• Depict and label the approximate Ordinary High Water (OHW)/High Guidance Level (HGL), Low Guidance Level (LGL), and associated depths. Please check the water atlas for water level information. Please be advised, a minimum of 2’ of depth at LGL at end of ramp is required.
• Existing grade
• Approximate volume of dredge and fill material

Replacement Seawall:

• Existing seawall
• Location of replacement seawall in relation to the existing wall. Please be advised, the replacement wall shall not be constructed more than 18” in front of the existing wall unless technical documentation is provided demonstrating additional space is required to repair the wall. Please attached supporting documentation.
• Please review Chapter 5 of the Basis of Review to determine if your replacement seawall project meets exemption criteria.

Fence:

• Avoidance of trees indicated on plans
• Wetland substrate/ground level
• Ordinary High Water (OHW), if applicable
• Fence materials
• Height of fence from substrate and OHW

It is advised to schedule a pre-application meeting with EPC staff if the proposed project is not one of the ones listed above.

Instructions: Owner/Applicant must complete this authorization form. For multiple properties, please provide a separate form for each property. For business organizations (e.g. LLC, corporations, partnerships), this form must be signed by a person authorized to bind the organization. A business organization or person who has sufficient real property interest is required to authorize access to the property .

A.  OWNER/APPLICANT ACKNOWLEDGEMENT

By signing below, I or the business organization, am applying for a permit(s)¹ to conduct the activity(ies) described in the application. I am familiar with the information contained in the application and represent that it is true, complete and accurate. I understand this is an application and not a permit, and that work prior to approval may be a violation. I understand that this application and any permit issued thereto, does not relieve me of any obligation for obtaining any other required federal, state, water management district or local permit prior to commencement of activities. I agree to operate and maintain the proposed activity in compliance with permits and laws, unless the EPC authorizes transfer of the permit to a different responsible entity. I understand that my application will not be processed if there is any missing, insufficient, or invalid information or insufficient fees. I understand I may have to provide any additional information/data that may be necessary to provide reasonable assurance of evidence to show that the proposed project will comply with applicable environmental standards/laws. I agree that upon written concurrence, the EPC may make changes to the application based on revised drawings and/or additional information provided by agent or applicant. I further agree EPC can unilaterally change non-substantive typographical errors. I understand that knowingly making any false statement or representation in this application is a violation of EPC Act and rules and may result in, among other things, revocation of the permit or denial of the application.

By signing below, I certify that I, or the business organization, possess sufficient real property interest in or control over the land upon which the activities described in this application are proposed and that I have legal authority to grant permission to access those lands. I hereby grant permission, evidenced by my signature below, for staff of the EPC to access, inspect, and sample the lands and waters of the property as necessary for the review of the proposed works and other activities specified in this application. I authorize EPC, its agents, and assigns to enter the property as many times as may be necessary to make such review, inspection, and/ or sampling. Further, I agree to provide entry to the project site for such agents or personnel to monitor and inspect permitted work if a permit is granted.

C.  DESIGNATION OF AUTHORIZED REPRESENTATIVE (IF APPLICABLE)

By signing below, I authorize the representative listed below to act on my behalf, or on behalf of the organization, to process the application; to negotiate revisions; to accept or agree to conditions or stipulations; and to furnish, upon request, supplemental information in support of the application. In addition, I authorize the representative listed below to bind me, or the organization, to perform any requirements that may be necessary to procure the permit or authorization.