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' Part V: Additional Information for a Department of the Army Permit <br /> i 1. COE Application No. 2. <br /> (to be provided by COE) (Name of waterway) <br /> 3. Names and addresses of property owners adjoining your property: <br /> 4. Document other project alternatives(i.e.. other locations and/or construction methods, particularly those <br /> that would eliminate the discharge of dredged or fill material into waters or wetlands). <br /> 5. $:'i" x 11 " drawings in planview and Cross-section,showing the resource area and the proposed activ. <br /> ity within the resource area. Drawings must be to scale and should be clear enough for photocopying. <br /> Certification is required from the Division of Water Pollution Control before.the Federal permit can be <br /> issued.Certification may be obtained by contacting the Division of Water Pollution Control,I WinterStreet, <br /> Boston, Massachusetts 02108. <br /> Where the activity will take place within the area under the Massachusetts approved Coastal Zone <br /> Management Program,the applicant certifies that his proposed activity complies with and will be conducted <br /> in a manner that is consistent with the approved program. <br /> Information provided will be used in evaluating the application for a permit and is made a matter of public <br /> record through issuance of a public notice.Disclosure of this information is voluntary,however,if necessary <br /> Information is not provided, the application cannot be processed nor can a permit be issued. <br /> I herebv certify under the pains and penalties of perjury that the foregoing Notice of Intent and accompanying <br /> plans. oocument and supporting Casa are true and c mplete,to the best of my knowlecge. <br /> Signature of Ap cant Date <br /> Signature of Azpllcant's sentative Date <br /> FORME.r.p„ to EAG fere 43 <br /> ORM D9 XD 'SACE. 6 Mn 198." <br /> NfD 100 ITESTj, <br /> 1 MAY BZ CDu d.ramre, .aero.. a lmnt Drputmot of tDe Army .ap Sut• of MuureauIts .ppb.wen <br /> bre porma to aDuia perm,....• to perform .rant." is United Stun .um. TDe orti.. <br /> of pl.ppem.m end Boopt(01,18) Du eppr.•ed aDw porno reaw.d by te. u3 Army C.". <br /> of Enpne.It. OMB Some., 0:07.0076 .ad •.Onutee dote .r OC Sep,emarr 1910 .naive' TD,. <br /> •u..m eat -.11 De .•t is f p.,at tpp.. <br /> 3.7 <br />