2348_ERP_Section_A_-_62_330_060_-_EXECUTED.pdf

Form 62-330.060(1) - Application for Individual and Conceptual Approval Environmental Resource Permit, State 404 Program Permit, and Authorization to Use State-Owned Submerged Lands Incorporated by reference in subsection 62-330.060(1), F.A.C. (December 22, 2020) Section A, Application for Individual and Conceptual Approval

Environmental Resource Permit, State 404 Program Permit, and Authorization to Use State-Owned Submerged Lands

Florida Department of Environmental Protection/

Water Management Districts

Effective December 22, 2020

Form 62-330.060(1) - Application for Individual and Conceptual Approval Environmental Resource Permit, State 404 Program Permit, and

Incorporated by reference in subsection 62-330.060(1), F.A.C. (December 22, 2020) Section A, Instructions for Use of This Form:

This form is designed to assist you in submitting a complete application. All applications must include Section A- General Information for All Activities. Sections B through H list typical information that is needed based on the proposed activities and are only required as applicable. Part 1-C of Section A will guide you to the correct sections needed based on your proposed activities. Applicants are advised to consult Chapter 62-330, F.A.C., and the Environmental Resource Permit Applicant’s Handbook Volumes I and II for information regarding the ERP permitting process and requirements while preparing their application. Internet addresses for Chapter 62-330, F.A.C., and the Applicant’s Handbook, Agency contact information, and additional instructions for this form can be found in Attachment 1.

What Sections of the Application Must I Fill Out?

Type of Activity Section A

Section B

Section C

Section D

Section E

Section F

Section G

Section H

Section I

Fill in wetlands or waters for a single family residence?

Y Y N N N N N N Y, if in assumed waters

Docks, shoreline stabilization, seawalls associated with a single family residence?

Y Y N N N Y, as needed N N

Y, if in assumed waters

Wetland impacts (other than association with an individual residence)?

Y N Y N N N N N Y, if in assumed waters

Boating facilities, a marina, jetty, reef, or dredging?

Y N Y Y N Y, as needed N N

Y, if in assumed waters

Any work on state owned submerged land?

Y N Y N N Y N N

Y, if in assumed waters

Construction of a stormwater management system?

Y N Y, as needed N Y N N N N

Constructing a mitigation bank? Y N Y N Y, as needed N Y N Y, if in assumed waters

Creating a mine? Y N Y, as needed N N N N Y

Y, if in assumed waters

If you have any questions, or would like assistance completing this form, please contact the staff of the nearest office of either the Florida Department of Environmental Protection (DEP) or a Water Management District (WMD) (see Attachment 2).

Form 62-330.060(1) - Application for Individual and Conceptual Approval Environmental Resource Permit, State 404 Program Permit, and Authorization to Use State-Owned Submerged Lands Incorporated by reference in subsection 62-330.060(1), F.A.C. (December 22, 2020)

Section A, Page 3 of 11

Section A:

General Information for All Activities

Part 1: Name, Application Type, Location, and Description of Activity

A. Name of project, including phase if applicable:

B. This is for (check all that apply):

Construction and operation of new works, activities, and/ or a stormwater management system

Conceptual Approval of proposed works, activities and/ or a stormwater management system

Modification or alteration of existing works, activities, and/or a stormwater management system. Provide the existing DEP or WMD permit #, if known:

Note: Minor modifications do not require completion of this form, and may instead be requested by letter in accordance with section 6.2 of Applicant’s Handbook Volume I.

Maintenance or repair of works, activities, and/ or a stormwater management system previously permitted by the DEP or WMD. Provide existing permit #, if known:

Abandonment or removal of works, activities, and/ or a stormwater management system.

Provide existing DEP or WMD permit #, if known:

Operation of an existing unpermitted work, activity, and/or stormwater management system.

Construction of additional phases of a permitted work, activity, or system.

Provide the existing DEP or WMD permit #, if known:

A State 404 Program authorization:

Exemption General Permit Individual Permit

If requesting an Exemption or General Permit provide Rule #, if known:

By checking this box, I hereby voluntarily waive, in accordance with Rule

62-330.090(8), F.A.C., the agency action deadlines in section 5.5.3 of Volume I in the event my project also requires a State 404 Program authorization (other than an exemption) under Chapter 62-331, F.A.C., and request that the agency actions for the ERP and State 404 Program authorizations be issued at the same time. (This is strongly recommended to ensure consistency, and to reduce the potential need for project modifications to resolve inconsistencies that may occur when the agency actions are issued at different times.) If this box is checked and the Agency(ies) determines that no State 404 Program authorization is required, the Agency will continue to abide by section 5.5.3 of Volume I.

Form 62-330.060(1) - Application for Individual and Conceptual Approval Environmental Resource Permit, State 404 Program Permit, and

Incorporated by reference in subsection 62-330.060(1), F.A.C. (December 22, 2020) Section A, C. List the type of activities proposed. Check all that apply, and provide the supplemental information requested in each of the referenced application sections. Please also reference Applicant’s Handbook Volumes I and II for the type of information that may be needed.

Activities associated with one single-family residence, duplex, triplex, or quadruplex that do not qualify for an exemption or a General Permit: Provide the information requested in Section B. Do not complete Section C.

Activities within wetlands or surface waters, or within 25 feet of a wetland or surface water, (not including the activities associated with an individual single-family residence). Examples include dredging, filling, outfall structures, docks, piers, over-water structures, shoreline stabilization, mitigation, reclamation, and restoration/enhancement. Provide the information requested in Section C.

Activities within navigable or flowing surface waters such as a multi-slip dock or marina, dry storage facility, dredging, bridge, breakwaters, reefs, or other offshore structures: In addition to Section C, also provide the information requested in Section D.

Activities that are (or may be) located within, on, or over state-owned submerged lands (See Chapter 18-21, F.A.C. https://www.flrules.org/gateway/ChapterHome.asp?Chapter=18-21): In addition to Section B or C, also provide the information requested in Section F.

Construction or alteration of a stormwater management system serving residential, commercial, transportation, industrial, agricultural, or other land uses, or a solid waste facility (excluding mines that are regulated by DEP). Provide the information requested in Section E.

Creation or modification of a Mitigation Bank (refer to Chapter 62-342, F.A.C.

https://www.flrules.org/gateway/ChapterHome.asp?Chapter=62-342): Provide the information requested in Section G.

Mines (as defined in Section 2.0 of Applicant’s Handbook Volume I) that are regulated by the DEP: Provide the information requested in Section H.

Other, describe:

Please contact the Agency to determine which additional sections of the application are needed. See Attachment 2 for Agency contacts.

D. Describe in general terms the proposed project, system, works, or other activities. For permit modifications, please briefly describe the changes requested to the permit:

Form 62-330.060(1) - Application for Individual and Conceptual Approval Environmental Resource Permit, State 404 Program Permit, and

Incorporated by reference in subsection 62-330.060(1), F.A.C. (December 22, 2020) Section A, E. Project/Activity Street/Road Address or other location (if applicable):

City: County(ies): Zip:

Note: For utility, road, or ditch/canal activities, provide a starting and ending point using street names and nearest house numbers or provide length of project in miles along named streets or highways.

F. Project location map and Section, Township, and Range information (use additional sheets if needed):

Please attach a location map showing the location and boundaries of the proposed activity in relation to major intersections or other landmarks. The map should also contain a north arrow and a graphic scale; show Section(s), Township(s), and Range(s); and must be of sufficient detail to allow a person unfamiliar with the site to find it.

Section(s): Township: Range: Land Grant name, if applicable:

Section(s): Township: Range:

1. Section(s): Township: Range:

G. Latitude (DMS) o ’ ” Longitude (DMS) o ’ ” (Taken from central location of the activity). Explain source for obtaining latitude and longitude (i.e. U.S.G.S. Quadrangle Map, GPS, online resource):

H. Tax Parcel Identification Number(s):

[Number may be obtained from property tax bill or from the county property appraiser’s office; if on multiple parcels, provide multiple Tax Parcel Identification Numbers]

I. Directions to Site (from major roads; include distances and landmarks as applicable):

J. Project area or phase area: acres

K. Name of waterbody(ies) (if known) in which activities will occur or into which the system will discharge:

Form 62-330.060(1) - Application for Individual and Conceptual Approval Environmental Resource Permit, State 404 Program Permit, and

Incorporated by reference in subsection 62-330.060(1), F.A.C. (December 22, 2020) Section A, The following questions (M-O) are not applicable to activities related to an individual single-family residence, including a dock, pier, and/or seawall associated with that residence.

L. Is it part of a larger plan of development or sale? yes no

M. Impervious or semi-impervious area excluding wetlands and other surface waters (if applicable):

acres or square feet

N. Volume of water the system is capable of impounding (if applicable):

Normal Pool: acre-feet. Depth ft.

Maximum Pool: acre-feet. Depth ft.

Part 2: Supplemental Information, and Permit History

A. Is this an application to modify an existing Environmental Resource Permit or to construct or implement part of a multi-phase project, such as a project with a Conceptual Approval permit? Yes No (If you answered “yes”, please provide permit numbers below):

Agency Date Permit/Application No. Project Name

B. Indicate if there have been any pre-application meeting(s) with the DEP, WMD, or delegated local government, or other discussions, meetings, or coordination with other stakeholders or agencies about the proposed project, system or activity. If so, please provide the date(s), location(s) of the meeting, and the name(s) of Agency staff that attended the meeting(s):

Agency Date Location Meeting Attendees

Form 62-330.060(1) - Application for Individual and Conceptual Approval Environmental Resource Permit, State 404 Program Permit, and

Incorporated by reference in subsection 62-330.060(1), F.A.C. (December 22, 2020) Section A, C. Attach a depiction (plan and section views), which clearly shows the works or other activities proposed to be constructed. Use multiple sheets, if necessary, a scale sufficient to show the location and type of works, and include a north arrow and a key to any symbols used. Specific information to be included in the plans is based on the activities proposed and is further described in Sections B-H. However, supplemental information may be required based on the specific circumstances or location of the proposed works or other activies.

D. Processing Fee: Please submit the application processing fee along with this application form and supplemental information. Processing fees vary based on the size of the activity, the type of permit applied for, and the reviewing Agency. Please reference Appendix D of Applicant’s Handbook Volume I to determine the appropriate fee.

Part 3: Applicant and Associated Parties Information Instructions: Please complete the following sections. For corporations, list a person who is a registered agent or officer of the corporation who has the legal authority to bind the corporation.

A. Applicant (Entity Must Have Sufficient Real Property Interest) This is a Contact Person for Additional Information

Last Name: First Name: Middle Initial:

Title: Company:

Address:

City: State: Zip:

Home Telephone: Work Telephone:

Cell Phone: E-mail Address:

Correspondence will be sent via email, unless you check here to receive it via US Mail:

Form 62-330.060(1) - Application for Individual and Conceptual Approval Environmental Resource Permit, State 404 Program Permit, and

Incorporated by reference in subsection 62-330.060(1), F.A.C. (December 22, 2020) Section A, B. Land Owner(S) (If Different or in Addition to Applicant) Check here if land owner is also a co-applicant

Last Name: First Name: Middle Initial:

Title: Company:

Address:

City: State: Zip:

Home Telephone: Work Telephone:

Cell Phone: E-mail Address:

Correspondence will be sent via email, unless you check here to receive it via US Mail:

C. Operation and Maintenance Entity (see Applicant’s Handbook I, Section 12.3)

Last Name: First Name: Middle Initial:

Title: Company:

Address:

City: State: Zip:

Home Telephone: Work Telephone:

Cell Phone: E-mail Address:

Correspondence will be sent via email, unless you check here to receive it via US Mail:

D. Co-Applicant (If Different or In Addition to Applicant and Owner)

Last Name: First Name: Middle Initial:

Title: Company:

Address:

City: State: Zip:

Home Telephone: Work Telephone:

Cell Phone: E-mail Address:

Correspondence will be sent via email, unless you check here to receive it via US Mail:

E. Registered Professional Consultant This is a contact person for additional information

Last Name: First Name: Middle Initial:

Title: Company:

Address:

City: State: Zip:

Home Telephone: Work Telephone:

Cell Phone: E-mail Address:

Correspondence will be sent via email, unless you check here to receive it via US Mail:

Form 62-330.060(1) - Application for Individual and Conceptual Approval Environmental Resource Permit, State 404 Program Permit, and

Incorporated by reference in subsection 62-330.060(1), F.A.C. (December 22, 2020) Section A, Environmental Consultant This is a contact person for additional information

Last Name: First Name: Middle Initial:

Title: Company:

Address:

City: State: Zip:

Home Telephone: Work Telephone:

Cell Phone: E-mail Address:

Correspondence will be sent via email, unless you check here to receive it via US Mail:

F. Agent Authorized to Secure Permit (If Different from Consultant)

Last Name: First Name: Middle Initial:

Title: Company:

Address:

City: State: Zip:

Home Telephone: Work Telephone:

Cell Phone: E-mail Address:

Correspondence will be sent via email, unless you check here to receive it via US Mail:

If necessary, please add additional pages for other contacts and property owners related to this project.

G. Real Property Interest

a. Permits are only issued to entities having sufficient real property interest as described in Section 4.2.3(d) of Applicant’s Handbook Volume I. Please attach evidence of the applicant’s real property interest over the land upon which the activities subject to the application will be conducted, including mitigation areas (if applicable). Refer to Sections 4.2.3(d)-(e) for sufficient real property interest documentation.

b. For activities that require a recorded notice in accordance with rule 62-330.090(7), F.A.C., please provide either the complete legal description of the property or a copy of the pages of the document recorded in the public records that contains the complete legal description. If the land upon which the proposed activities are to occur is not owned by the applicant, the applicant must also provide copies of any right-of-way, leases, easements, or other legal agreement which authorizes the applicant to perform the activities on those lands.

10/22/2025