Texas



[pic] |Sand and Gravel General Permit Application | | |

|Section I. Applicant Information | |

|1. |Applicant Name: |      | |

|2. |Mailing Address: |      | |

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|3. |Telephone Numbers: | |

| |Voice: |(       )       |Cell: |(       )       |Fax: |(       )       | |

|4. |Comptroller’s ID Number or Federal Employer’s Identification Number (FEIN): |      | |

|5. |Previous or current Permit Number: |      | |

|6. |Agent or other person acting on behalf of Applicant: |      | |

|7. |Mailing address if different from Applicant: |      | |

| |      | |

|8. |Telephone numbers if different from Applicant: | |

| |Voice: |(       )       |Cell: |(       )       |Fax: |(       )       | |

|Section II. Location of Proposed Activity | |

|9. |Name of water body: |      | |

|10. |County of proposed activity: |      | |

|11. |Nearest city or town with a post office: |      | |

|12. |Nearest upstream state highway crossing: |      | |

| |Distance from proposed activity: |      | |

|13. |Nearest downstream state highway crossing: |      | |

| |Distance from proposed activity: |      | |

|14. |USGS 7½ Minute Quad Map number: |      | |

|Section III: Description of Proposed Activity | |

|15. |Description of proposed activity: | |

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|16. |Volume of sedimentary material to be disturbed monthly (Cubic yards per month): |      | |

|17. |Volume of sedimentary material to be disturbed annually (Cubic yards year): |      | |

|18. |Intended final disposal area for removed materials: |      | |

|19. |Surface area of bottom to be disturbed (in square feet): |      | |

|20. |Date that project is proposed to begin: |      | |

|21. |Duration of disturbance period: |      | |

|(Section III, continued) |

|22. |Description of measures proposed to minimize harm to aquatic and riparian habitat: | |

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|23. |U.S. Army Corps of Engineers (COE) Permit Number, Individual, General, or Nationwide: | |

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|24. |If COE permit application is pending, state application date and COE office reviewing application: | |

| |Application date: |      |COE office: |      | |

|Section IV: Public Notice and Requirements for General Permits [31 TAC § 69.116]. | |

|25. |Name of daily newspaper of greatest circulation in the county or counties to be affected by the issuance of the permit with address and telefax | |

| |number to be used for public notification: | |

| |Newspaper name: |      |Telefax number: |(       )       | |

| |Newspaper telephone number: |(       )       | |

| |Newspaper Web site: |      | |

| |Address: |      | |

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|Texas Parks and Wildlife Department maintains the information collected through this form. With few exceptions, you are entitled to be informed about the |

|information we collect. Under Sections 552.021 and 552.023 of the Texas Government Code, you are also entitled to receive and review the information. Under |

|Section 559.004, you are also entitled to have this information corrected. |

|[pic] |Texas Parks & Wildlife Department | |

| |Sand and Gravel General Permit Application | |

| | | |

| |Signature Page | |

|Signature on Application: The person who signs the application form should be the Applicant. When another person signs on behalf of the Applicant his/her title |

|or relationship to the Applicant should be stated. In all cases, the person who signs the form must be authorized to do so by the Applicant. A person who signs |

|an application must provide proof of authorization. A copy of the authorization letter must be included in the application package. An application submitted by |

|a corporation must be signed by a principal executive officer of at least the level of vice-president or by a duly authorized representative, if such |

|representative is responsible for the overall operation of the facility that will conduct the activities authorized by the permit requested. In the case of a |

|partnership or sole proprietorship, the application must be signed by a general partner or the proprietor, respectively. In the case of a municipal, state, |

|federal or other public facility, the application must be signed by a principal executive officer, a ranking elected official or another duly authorized employee.|

|I, |      |certify under penalty of law that this document |

|and all attachments were prepared under my direction or supervision in accordance with a system designed to ensure that qualified personnel gathered and evaluated|

|the information submitted. Based on my inquiry of the person or persons who managed the system, or those persons directly responsible for gathering the |

|information, this information is, to the best of my knowledge and belief, true, accurate and complete. I am aware that there are significant penalties for |

|submitting false information, including the possibility of a fine and imprisonment for known violations. |

| |      | | | |      | |

| |Date | |Signature | |Title | |

| |Subscribed and sworn to before me by the said |      |on this |

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|[pic] | | |

| |Notary Public | |

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|[pic] |Texas Parks & Wildlife Department | |

| |Sand and Gravel General Permit Application | |

| |Supplement A | |

| |Permission to Enter and Cross | |

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|Applicant’s Name: |      | |

| My name is |      |and I am over the age of 18 years. |

|I am the owner or otherwise have the authority to control access to the property described in this document. I hereby grant |

|permission to employees of the Texas Parks and Wildlife Department to enter and/or cross my property for the purposes of inspecting|

|the bed and banks of public waters, in conjunction with, and for the purposes of, reviewing the Applicant’s request for a Sand and |

|Gravel Permit from the Department. I understand that Department employees may take photographs and make drawings or maps of my |

|property where it has a common boundary with public waters and that such photographs, drawings or maps will become public records. |

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| |      | |      | |

| |Date | |Owner or Authorized Representative | |

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|[pic] |Texas Parks & Wildlife Department | |

| |Sand and Gravel General Permit Application | |

| |Attachments and Supplemental Materials | |

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|1. A map showing the vicinity of the proposed site, such as a county map; |

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|2. A scale drawing of the proposed operating area that indicates: |

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|The location of the operation, identified by prominent landmarks and showing the limits of the proposed dredging (show distances in|

|miles, feet, etc.); |

|The name of the waterway; |

|Graphic scale of the drawing; |

|The direction of north by arrow; |

|The direction of flow in streams and the direction of ebb and flow in tidal waters; |

|The mean high and low waterlines in tidal areas and the ordinary high and low waterlines in a lake or stream; |

|The property lines and names of adjacent property owners; |

|If the waterway separates two or more counties, show the county lines and the names of the counties; |

|The location of the gravel washing site with settling ponds, if applicable; |

|The average depth in feet and/or inches of the water at 200-feet intervals; |

|Location of stockpile, if applicable. |

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|3. At least four color photographs of the site adequately illustrating where the |

|operation will be conducted: |

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|One from each side of the river at the work area, showing the banks, river, and vegetation; |

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|(b) One from the downstream and upstream ends of the project area, showing river and banks from close to the elevation of the |

|water. |

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Notary Seal

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