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Home My WebLink AboutKlima Weeks Civil Engineering, Inc. - 2006 09 21 SECTION A Are any of the activities described in this application proposed to occur in, on, or over wetlands or other surface waters? Dyes IZI no A. Type of Environmental Resource Permit Requested (check at least one) o Noticed General - include information requested in Section B. o Standard General (Single Family Dwelling)-include information requested in Sections C and D. o Standard General (all other projects) - include information requested in Sections C and E. o Individual (Single Family Dwelling) - include information requested in Sections C and D. o Individual (all other projects) - include information requested in Sections C and E. o Conceptual - include information requested in Sections C and E. o Mitigation Bank Permit (construction) - include information requested in Section C and F. ( If the proposed mitigation bank involves the construction of a surface water management system requiring another permit defined above, check the appropriate box and submit the information requested by the applicable section. ) o Mitigation Bank (conceptual) - include information requested in Section C and F. IZI Standard General Stormwater - include information requested in Sections C and H o Individual Stormwater - include information requested in Sections C and H B. Type of activity for which you are applying (check at least one) IZI Construction or operation of a new system including dredging or filling in, on or over wetlands and other surface waters. o Alteration or operation of an existing system which was not previously permitted by a WMD or DEP. o Modification of a system previously permitted by a WMD or DEP. Provide previous permit numbers. o Alteration of a system 0 Extension of permit duration 0 Abandonment of a system o Construction of additional phases of a system 0 Removal of a system C. Are you requesting authorization to use State Owned Submerged Lands. 0 yes IZI no (If yes include the information requested in Section G.) D. For activities in, on or over wetlands or other surface waters, check type of federal dredge and fill permit requested: o Individual 0 Programmatic General o General 0 Nationwide IZI Not Applicable E. Are you claiming to qualify for an exemption? Dyes IZI no If yes provide rule number if known._ Pg 1 of 4 OWNER(S) OF LAND ENTITY TO RECEIVE PERMIT (IF OTHER THAN OWNER) NAME Ronald W. McLemore, City Manager NAME ADDRESS 1126 East SR 434 ADDRESS CITY, STATE, ZIP Winter Springs, FL 32708 CITY, STATE, ZIP COMPANY AND TITLE City Manager, Winter Springs COMPANY AND TITLE TELEPHONE (407) 327-5957 TELEPHONE ( ) FAX (407) 327-6686 FAX ( ) AGENT AUTHORIZED TO SECURE PERMIT (IF AN CONSULTANT (IF DIFFERENT FROM AGENT) AGENT IS USED) NAME NAME Jay A. Klima, P.E. COMPANY AND TITLE COMPANY AND TITLE Klima Weeks Civil Engineering, Inc. ADDRESS ADDRESS 385 Douglas Avenue, Suite 2100 CITY, STATE, ZIP CITY, STATE, ZIP A1tamonte Springs, FL 32714 TELEPHONE ( ) TELEPHONE (407) 478-8750 FAX ( ) FAX (407) 478-8749 Name of project, including phase if applicable Sunshine Park Senior Center Pool Add. Is this application for part of a multi-phase project? Dyes ~ no Total applicant-owned area contiguous to the project 11.80 ac Total project area for which a permit is sought 0.83 ac Impervious area for which a permit is sought 0.70 ac What is the total area (metric equivalent for federally funded projects) of work in, on, or over wetlands or other surface waters? Q..acres 2 square feet 2 hectares 2 square meters If a docking facility, the number of proposed new slips. - Project location (use additional sheets, if needed) County(ies) Seminole Section(s) 26 Township 20 South Range 30 East Section(s) _ Township _ Range _ Land Grant name, if applicable _ Tax Parcel Identification Number 26-20-30-5AR-OCOO-0140 Street address, road, or other location Edeemon Drive City, Zip Code if applicable Winter Sprines. FL 32708 Pg 2 of 4 Describe in general terms the proposed project, system, or activity. The proiect involves the construction of a new buildine with associated sidewalks on the south side of the existine facilitv alone with the addition of new parkine on the south side of the facilitv. The site was not previouslv permitted therefore we are submittine a permit for the new improvements onlv. Drv retention is proposed located on the site near the southwest corner. If there have been any pre-application meetings, including at the project site, with regulatory staff, please list the date(s), location(s), and names of key staff and project representatives. _ Please identify by number any MSSW/Wetland resource/ERP/ACOE Permits pending, issued or denied for projects at the location, and any related enforcement actions. Agency Date No.\Type of Application Action Taken Note:The following information is required only for projects proposed to occur in. on or over wetlands that need a federal dredge and fill permit and/or authorization to use state owned submerged lands and is not necessary when applying solely for an Environmental Resource Permit. Please provide the names, addresses and zip codes of property owners whose property directly adjoins the project (excluding applicant). Please attach a plan view showing the owner's names and adjoining property lines. Attach additional sheets if necessary. 1. 2. 3. 4. Pg 3 of 4 By signing this application form, I am applying, or I am applying on behalf of the applicant, for the permit and any proprietary authorizations identified above, according to the supporting data and other incidental information filed with this application. I am familiar with the information contained in this application and represent that such information is true, complete and accurate. I understand this is an application and not a permit, and that work prior to approval is a violation. I understand that this application and any permit issued or proprietary authorization issued pursuant 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 construction. I agree, or I aaree on behalf of my corporation, to operate and maintain the permitted system unless the permitting agency authorizes transfer ,of th~ permit to a responsible operation entity. I understand that knowingly making any false statement or representation in thi~ 'application is a violation of Section 373.430, F.S. and 18 U.S.c. Section 1001. R~ald W.'McLemo~ TyFed/Printed Name ol-Appl1c-ant (If no Agent is used) or Agent (If one is so authorized below) :.)~.iI /./1.. -'/V1:~" /.; 'H ~v.V' . ~f r 'CJn1.f1.V Signature of Applkiu'ltlAgeJit q-;) {- Db Date City Manaeer (Corporate Title if applicable) AN AGENT MAY SIGN ABOVE ONLY IF THE APPLICANT COMPLETES THE FOLLOWING: I hereby designate and authorize the agent listed above to act on my behalf, or on behalf of my corporation, as the agent in the processing of this application for the permit and/or proprietary authorization indicated above; and to furnish, on request, supplemental information in support of the application. In addition, I authorize the above-listed agent to bind me, or my corporation, to perform any requirement which may be necessary to procure the permit or authorization indicated above. I understand that knowingly making any false statement or representation in this application is a violation of Section 373.430, F.S. and 18 U.S.c. Section 1001. TypedlPrinted Name of Applicant Signature of Applicant/Agent Date (Corporate Title if applicable) Please note' The annlicant's ori"inal silmatllre (not a conv) is reollired ahove. PERSON AUTHORIZING ACCESS TO THE PROPERTY MUST COMPLETE THE FOLLOWING: I either own the property described in this application or I have legal authority to allow access to the property, and I consent, after receiving prior notification, to any site visit on the property by agents or personnel from the Department of Environmental Protection, the Water Management District and the U.S. Army Corps of Engineers necessary for the review and inspection of the proposed project specified in this application. I authorize these agents or personnel to enter the property as many times as may be necessary to m2k~ such re;v{ow and inspection. Further, I agree to provide entry to the project site for such agents or personnel to monitor permitted work if <t p.er~it is granted. Ronald W. McLemore TypedlPrinjed Name of AppliC"~1t Ii ~rJ' 11;:'.1 . . '7J, 1 ' . /i-~lilP Signature ofApplicant//\gent ),' " ' ;-).1-66 Date City Mana2er (Corporate Title if applicable) Pg 4 of 4