2497 Info.pdf

;orps of Engineers Jepartment of the Army

Corps File No.

APPLICATION FOR PERMIT________ -

I FOR OFFICIAL USE ’ |

State of Michigan Department of Natural Resources Land Resource Programs

PLEASE READ INSTRUCTIONS BEFORE FILLING OUT THIS APPLICATION

-----------------------------------------------------------------AGENT.'CONTRACTOR (firm name. II known)

PRINT OR TYPE

l. APPLICANT (individual or corporate name)

^TATE OF MICHIGAN r DMR - WILDLIFE DIVISION address ~- - - - - - - - - TIMOTHY PAYNE

38980 SEVEN MILE ROAD______ ________________

CITY

LIVONIA

TELEPHONE

(Work) (Home)_______________

2. If applicant is not owner of the

STATE ZIP

48152MI

313-953-0241 ___

SOC. SECURITY or FED. |.O. No.

address

CITY

state ZIP telephone property where the proposed activity will be conducted, provide name and address of owner and include letter of authorization from owner: pity OWNER’S NAME MAILING ADDRESS pni IY

STATE OF MICHIGAN - MB - HOLLY RECREATION AREA S100 GRANGE HALL RD HOLLY

STATE ZIP

MI 48442

3. PROJECT LOCATION Street/Road Village/City

HOLLY RECREATION AREA

County

OAKLAND

Township

GROVELAND

HOLLY

Town Range Secnon(s)

05N 08E 7 ’

BODY OF WATER (Lake stream creek, pond, or drain)

THREAD CREEK •

Subdivision or Plat Lot No. Private Claim

1. PROJECT INFORMATION

!•> ^ST^Sbbish’th? existing control structure eike and spillways in a current existing

WE ARE REQUESTING A FIVE-YEAR MAINTENANCE PERMIT FOR THIS PROJECT.___________________ .________ _

(b) Attach drawings of the proposed activity prepared in accordance with the DRAWING REQUIREMENTS p g R ( d nunuii ______ c—-— ------------------------------------ - — 1 ■ . See Samples of Drawings rwquireu i.c) Check appropriate Project Type (below)-------------------------------------------- --------------------------------------------- -

1) DPfcredging. Filling. Draining or'Construction Work in Inland , 2. 3. 4, or 5 Lakes or Streams. Great Lakes Bottomlands or Wetland Areas ....................................................................'

2) □ Work in Riverine Flood Plain ..................... (See SPECIAL INSTRUCTIONS. Sect.on 1. on back of th.s form . ? g g 1Q

3) □ New or Replacement Bridge or Culvert ..(See SPECIAL INSTRUCTIONS. Section 2. on back o his o

4) □ Dam Construction or Reconstruction ........ (See SPECIAL INSTRUCTIONS. ^Xnon^Xck und'er 'SPECIAL INSTRUCTIONS" .

NOTE: If boxes 2. 3 and/or 4. above, are checked provide appropriate additional information on the b___________________________ ______________

(d) PROPOSED USE: 1. E Public; □ Private; □ Commercial; □ Other (specify^. ^ c„^om i^ntic-Tank) KJ No □'Yes (Check appropriate box) 2. Will the project site be served by a new on-site Sewage Disposal Sy------- (—P--------------------------------------- -—-

fe) Location of Source of Fill if more the bU cubic yards! are squirted fu< ulhm than eemmorciai s ----------------- * Section - —------------------------------------------7-------------------- Town Range becuon

County Townsnip i a ^

DAi/i amti GROVELAND _____ 05N_________ ----------- ------------ " ’FunheSon (prov.de vicinity map of Source Site (Sample Drawing 5) if more .han 50 cubic yards and source .s other than commercial)

SEE ATTACHED^----- -—------ ---------------------------7----

(f) Dredge Spoils Disposal Location Site (if required):---------------------------- .---------------------- County Township- Town Ra 9

Further Description (provide vicinity map lor Disposal Site (sample Drawing 3) FEB j 1499g----------- --------------—

(g) Describe any project alternatives considered.

If fill is required, is project water dependent? Q No Yes

(h) Date activity will commence if permit is issued ._. q-Q?-

(i) Is any portion of the requested project now complete? □ No submit and give the date activity was completed.------------

; be completed 1-0,

□ Yes. If yes. identify the completed portion on the drawings you

DO NOT WRITE IN THIS SPACE — FOR CASHIER USE ONLY

APPLICATION CONTINUED ON

REVERSE SIDE.

PR 2731

REMOVE INSTRUCTIONS BEFORE MAILING ___ Rev. 9/82 prov.de lx c c

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