Laserfiche WebLink
ENVIRONMENTAL RESOURCE <br /> � PERMIT APPLICATION <br /> 9 <br /> ; � SOUTHWEST FLOR/DA WATER <br /> ''d�, � ,� M.4NAGEMENT D/STR/GT � <br /> � <br /> ��'�'��E`'� 0 2379 BROAD STREET ' BROOKSVILLE, FL 346P4-6899 <br /> (352) 796-7211 OR FLOR/DA WATTS 1(800) 423-1476 <br /> FdR AGENCY USE ONLY <br /> ACOE Rpj�Cadan # DEPIWMD Application # <br /> �It4s'� Date Re�ehted <br /> � .. ��t,� � N N O Fee Rebelv�d S <br /> Pr' t�fe�Ct Lop�itade N N O Fde Recaipt � <br /> SECTION A <br /> PART 1: <br /> Are any of the activities described in this apptication proposed to occur in, on, or over wedands or other surface waters? <br /> O yes �no <br /> Is this application being filed by or on behalf of an entity eligible for a fee reduction? O yes ■ no <br /> PART 2: <br /> A. Type of Environmental Resource Permit Requested (check at least one) <br /> ❑ Noticed General — include information requested in Section B. <br /> ❑ Standard General (single-family dwelling)-include information requested in Sections C and D <br /> ❑ Standard General (all other projects) - include information requested in Sections C and E. <br /> ■ Standard General (minor systems) - include information requested in Sections C and H. <br /> ❑ StandaM General (borrow pits) - include information requested in Sections C and I. <br /> ❑ Individual (single family dwelling) - include information requested in Sections C and D. <br /> ❑ Individual (all other projects) - include information requested in Sections C and E. <br /> ❑ Individual (borrow pits) - include information requested in Sections C and I. <br /> ❑ Conceptual — include information requested in Sections C and E. <br /> ❑ Mitigation Bank (construction) - include information requested in Section C and F <br /> (If the proposed mitigation bank invoNes the construction of a surface water management system requiring another permit <br /> listed above, check the appropriate box and submit the information requested by the applicable section.) <br /> ❑ Mitigation Bank (conceptual) - include information requested in Section C and F. <br /> B. Type of activity for which you are applying (check at least one) <br /> ❑ Construction or operation of a new system, including dredging or filling in, on or over wetlands and other surface waters. (If <br /> reapplying for an expired, denied or withdrawn permiU application, please provide previous permit # <br /> ❑ Alteration or operation of an existing system which was not previously permitted by SWFWMD or DEP. <br /> ■ Modification of a system previously permitted by SWFWMD or DEP. Provide previous permit # <br /> 13268.0 8� 13268.1 and check applicable modification type. <br /> ■ Alteration of a system ❑ Extension of permit duration ❑ Abandonment of a system <br /> ❑ Construction of additional phases of a system O Removal of a system <br /> C. Are you requesting authorization to use State Owned Submerged Lands. ❑ yes ■ no <br /> If yes, include the information requested in Section G. <br /> D. For activities in, on or over wetlands or other surface waters, check type of federal dredge and fill permit requested: <br /> ❑ Individual ❑ Programmatic General ❑ General ❑ Nationwide ■ Not Applicable <br /> E. Are you claiming to qualify for an exemption? � yes ■ no <br /> If yes, provide rule number if known <br /> FORM 547.27/ERP(8-94)A Page 1 of 5 <br />