MAIW 20 - APPLICATION TO PERFORM MISCELLANEOUS ACTIVITIES IN WETLANDS This EPC application is for all miscellaneous activities in wetlands (MAIW) as provided in Section 1-11.10 Wetlands, Rules of the EPC. Standard criteria for activities allowable under current EPC Rules is provided in Section 6.0 of the EPC Applicant s Handbook (hyperlink). If submitting an application for a dock, boardwalk, riprap, swim access, etc. the fee is $380. If submitting an application for a hazard native tree removal (up to 3 trees) the fee is $50. If submitting an application for whole lake treatments less than 10 acres the fee is $490. If submitting an application for whole lake treatments greater than 10 acres, the fee is $680. Please be advised, an additional fee may be required if this project does not meet FDEP exemption criteria, as applicable. Incomplete applications, including omission of required site plans drawings and documentation or fee, will not be processed until all missing information is provided. Please include drawings that show 1) parcel boundaries, 2) existing shoreline, 3) wetland boundary, and 4) location of proposed activities. Return completed applications to Environmental Protection Commission (EPC) Attn: Wetlands Division, 3629 Queen Palm Drive, Tampa, FL 33619. 1. Property Owner Information Request to be present at site inspection First Name _ Last Name Company Name (if applicable) Street Address CityState_ Zip_ Owner Phone Fax E-mail 2. Agent Information (if applicable) Request to be present at site inspection First Name _ Last Name Company Name (if applicable) Street Address CityState_ Zip_ Phone_ Fax E-mail 3. Site Information Is the proposed project: ( ) New Work ( ) Maintenance/Renewal (Attach copy of previous permit) ( ) Addition/Modification (Attach copy of previous permit) Proposed use: () Private Single Dwelling () Private Multi-Dwelling () Commercial () Other Folio #(s) of Site: (XXXXXX.XXXX) Section/Township/Range// EPC Form #MAIW20 Page 1 of 5 Revised 06/2018
Street Address City State Zip Name of Water Body/ Waterway at Site Timeframe for Project (approximate): Begin Date _ End Date Is this activity proposed to resolve a violation for the EPC or some other governmental agency? Yes_ No Violation Reference No. If yes, please attach documentation. 4. Type of Work Proposed: (check all that apply) Rip-Rap and Other Forms of Shoreline Maintenance Dredge Stabilization Fence Installation Replacement Seawall Bridging of a Natural Wetland Area Dock or Observation Deck Overhead Transmission Lines/Aerial Pipeline Boat Lift/ Boat Slip Subaqueous Utility Crossings Boat Ramp Mooring Buoys 25-ft wide Swim Access Path To Open Water Artificial Reefs & Freshwater Fish Attractors Tree Trimming* Vegetation: Removal of Wetland Vegetation* Vegetation: Maintenance, Trimming, Mowing* Other: (please specify)_ * If only nuisance vegetation removal is proposed, refer to the EPC s List of Nuisance Plants to determine if WNV 15-Application for Nuisance Vegetation Removal is appropriate (no fee). 5. Project Descriptions (as applicable) A. Dock, Observation Deck, or Elevated Boardwalk Proposed 1. Number of Docks/Deck Platforms Number of Boat Lifts/Slips_ 2. New Structural Area Square Feet 3. Overall Area of Facility _ Square Feet 4. Length of Boardwalk_ Linear Feet 5. Width of Boardwalk _ Linear Feet B. Replacement Seawalls, Rip-Rap or Headwalls Proposed 1. Length of Shoreline _ Linear Feet 2. Vertical Height Horizontal Linear Feet 3. Rip-Rap Slope: Horizontal to Vertical If backfill is proposed, the items below must be noted. 4. Total Volume _ 5. Total Area _ 6. Type of Material To Be Used* _ 7. Source of Material *Only clean fill material may be used, as defined within Section 62-701.730(15) as adopted in Chapter 1-7, Solid Waste, Rules of the EPC. C. Maintenance Dredge Proposed 1. Length _ Width Total Area EPC Form #MAIW20 Page 2 of 5 Revised 06/2018
2. Depths: Existing Proposed 3. Total Volume 4. Type of Material: 5. Storage Location of Material: 6. Documentation of Previous Permit: D. Vegetation Control Activities Proposed (including Tree Trimming) List the Plant Name, Control Method, and Herbicide Name or Tools. Additional sheets may be attached if needed. Control Method- Target Herbicide Name or Target Plant Name Herbicide, Mechanical, or Area Tools Hand Removal (Sq. Ft.) APPLICANT ACKNOWLEDGEMENT, AUTHORIZATION TO ACCESS PROPERTY, and DESIGNATION OF AUTHORIZED AGENT Instructions: For multiple applicants please provide a separate signature section for each applicant. For corporations/partnerships, the application must be signed by a person authorized to bind the corporation/partnership. A person who has sufficient real property interest is required to authorize access to the property. A. APPLICANT ACKNOWLEDGEMENT: By signing this application form, I am applying for the permit(s), according to the 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 may be a violation. I understand that this application and any permit issued thereto, does not relieve of any obligation for obtaining any other required federal, state, water management district or local permit prior to commencement of activities. I agree to operate and maintain the proposed activity in compliance with permits and laws, unless the EPC authorizes transfer of the permit to a different responsible entity. I understand that my application will not be processed if there is any missing, insufficient, or invalid information or insufficient fees. I understand I may have to provide any additional information/data that may be necessary to provide reasonable assurance of evidence to show that the proposed project will comply with applicable water quality standards or other environmental standards/laws. I agree that upon written concurrence, the EPC may make changes to the application based on revised drawings and/or additional information provided by agent or applicant. I further agree EPC can unilaterally change nonsubstantive typographically errors. I understand that knowingly making any false statement or representation in this application is a violation of EPC Act and rules, and may result in among other things, revocation of the permit or denial of the application. Typed/Printed Name of Applicant or Applicant s Authorized Agent Signature of Applicant or Applicant s Authorized Agent Date EPC Form #MAIW20 Page 3 of 5 Revised 06/2018
(Corporate Title if applicable) B. CERTIFICATION OF SUFFICIENT REAL PROPERTY INTEREST AND AUTHORIZATION FOR STAFF TO ACCESS TO THE PROPERTY: I certify that I possess sufficient real property interest in or control over the land upon which the activities described in this application are proposed and I have legal authority to grant permission to access those lands. I hereby grant permission, evidenced by my signature below, for staff of the EPC to access, inspect, and sample the lands and waters of the property as necessary for the review of the proposed works and other activities specified in this application. I authorize EPC, its agents, and assigns to enter the property as many times as may be necessary to make such review, inspection, and/ or sampling. Further, I agree to provide entry to the project site for such agents or personnel to monitor and inspect permitted work if a permit is granted. Typed/Printed Name Signature Date (Corporate Title if applicable) C. DESIGNATION OF AUTHORIZED AGENT (IF APPLICABLE): I [or my business entity] possess sufficient real property interest in or control over the land upon which the activities described in this application are proposed. I authorize the agent listed below to act on my behalf, or on behalf of my corporation, as the agent in the processing of this attached application for the permit; to negotiate revisions; to accept or agree to conditions or stipulations; 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 requirements which may be necessary to procure the permit or authorization indicated above. I understand that my application will not be processed if there is any missing, insufficient, or invalid information or insufficient fees. I understand that knowingly making any false statement or representation in this application is a violation of EPC Act and rules, and may result in among other things, revocation of the permit or denial of the application. AUTHORIZED AGENT NAME and E-MAIL: Typed/Printed Name of Applicant/Owner Signature of Applicant/Owner Date (Corporate Title if applicable) EPC Form #MAIW20 Page 4 of 5 Revised 06/2018
General Drawing Requirements for MAIW 20 Applications Some of the items on the below checklist may not be applicable to the type of work being proposed. Drawings which do not contain the necessary items will be considered incomplete, and will require revisions before the application can be considered complete. Iff you have any questions regarding what would be applicable to your proposal, please review the EPC Applicant s Handbook (hyperlink) and/or contact EPC staff prior to submittal. I. Plan View/Top View Show the existing shoreline, name of water body, approximate wetland boundary, and property lines with dimensions noted and/or scale provided. Show the location and dimensions of existing structures that may be applicable to the project (i.e., existing dock, boat ramp, rip-rap, seawall, etc.). Include a north arrow. Show approximate approximate mean high water lines (High Guidance Level) and low water lines (Low Guidance Level) if activity is in tidal areas. Show approximate ordinary high and low water levels if the proposed activity is in non-tidal areas (ponds, lakes, etc.) Show water depths to the bottom substrate taken at approximate mean low or ordinary low water levels in the vicinity of the proposed structure. Show principal dimensions of proposed structure or work to be performed (including boardwalks, paths, vegetation removal, etc.) in relation to property boundaries. Indicate materials proposed for construction activities. II. Cross-Sectional/Profile View Show the approximate mean or ordinary high and low water levels in relation to the shoreline and the proposed structure. Show the existing and proposed depths at the waterward end of the proposed work; or if excavation is proposed, show the requested grade. Show dimensions of proposed structure and identify any structures to be erected upon it (i.e., roof, railings, etc.). If fill is proposed, indicate type of fill proposed, show dimensions and volumes of material, and identify any structures to be constructed, and their relationship to the delineated wetland line. EPC Form #MAIW20 Page 5 of 5 Revised 06/2018