California Code of Regulations › Title 14 - Natural Resources › Division 5 - San Francisco Bay Conservation and Development Commission › Appendices › Appendix D - BCDC Application Form December 28, 2020

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Box 1 Property Ownership and Applicant
				  Information
(must be completed by all applicants)
a. APPLICANT:
[] Owns project site [] Leases project site [] Homeowner
				  Association owns/will own []Other Property Rights: __________APPLICANT'S
				  REPRESENTATIVE: [] None
Name/Title: __________ Name/Title: __________
Address: __________ Address: __________
City, State, Zip: __________ City, State, Zip:
				  __________
Telephone: ___/__________ Fax: ___/__________ Telephone:
				  ___/__________ Fax: ___/__________
Email: __________ Email: __________
I hereby authorize
__________
to act
				  as my representative and bind me in all matters concerning this
				  application.
___________________________
___________________________
___________________________
Signature of Applicant
Print
						  Name
Date
b. CO-APPLICANT:
[] Owns project site [] Leases project site [] Homeowner
				  Association owns/will own [] Other Property Rights: __________
CO-APPLICANT'S REPRESENTATIVE: [] None
Name/Title: __________Name/Title: __________
Address: __________ Address: __________
City, State, Zip: __________ City, State, Zip:
				  __________
Telephone: ___/__________ Fax: ___/__________ Telephone:
				  ___/__________ Fax: ___/__________
Email: __________ Email: __________
I hereby authorize
__________
to act
				  as my representative and bind me in all matters concerning this
				  application.
___________________________
___________________________
___________________________
Signature of Co-Applicant
Print
						  Name
Date
c. PROPERTY OWNER: [] Same As Applicant or Co-Applicant
				  OWNER'S REPRESENTATIVE: [] None
Name/Title: ___________________________
Name/Title: ___________________________
Address: ___________________________
Address: ___________________________
City, State, Zip: ___________________________
City, State, Zip: ___________________________
Telephone: ___/_______ Fax:
						  ___/___________________________
Telephone: ___/_______ Fax:
						  ___/___________________________
Email: ___________________________
Email: ___________________________
I hereby authorize
__________
to act
				  as my representative and bind me in all matters concerning this
				  application.
___________________________
___________________________
___________________________
Signature of Owner
Print
						  Name
Date
d. Provide documentation of property interests, such as a
				  copy of a grant deed, lease or easement, and Conditions Covenants and
				  Restrictions, for a homeowner's association, that demonstrates that the owner
				  or applicant has adequate legal interest in the property to undertake the
				  proposed project. See Commission regulations Appendix F for complete
				  details.
e. DISCLOSURE OF CAMPAIGN CONTRIBUTIONS:
The following contributions of more than $250 were made by
				  the applicant or applicant's representative to a BCDC commissioner or
				  commissioner's alternate in the preceding twelve months to support the
				  commissioner's or alternate's campaign for election to a local, state or
				  federal office.
Contribution Made To
Contribution Made
						  By:
Date of Contribution:
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
[] No such contributions have been made.
f. CERTIFICATION OF ACCURACY OF INFORMATION AND AUTHORIZATION
				  TO INSPECT:
I hereby certify under penalty of perjury that to the
				  best of my knowledge the information in this application and all attached
				  exhibits is full, complete, and correct, and I understand that any misstatement
				  or omission of the requested information or of any information subsequently
				  requested shall be grounds for denying the permit, for suspending or revoking a
				  permit issued on the basis of these or subsequent representations, or for the
				  seeking of such other and further relief as may seem proper to the Commission.
				  I further agree that the Commission staff may, with 24 hours notice, inspect
				  the project site while this application is pending.
[]
						  ___________________________
___________________________
Signature of Applicant or Applicant's
						  Representative
Date
[] ___________________________
___________________________
Signature of Co-applicant or Co-applicant's
						  Representative
Date
[] ___________________________
___________________________
Signature of Co-applicant or Co-applicant's
						  Representative
Date
[] ___________________________
___________________________
Signature of Co-applicant or Co-applicant's
						  Representative
Date
Box 2 Total Project and Site Information
(must be completed by all applicants)
a. Project Street Address:__________
b. City, County, Zip:__________
c. Assessor's Parcel Number(s):__________ __________
d. Latitude: __________Longitude:__________
e. Previous BCDC permit number(s) for work at this
				  site:__________
f. Project Name: __________
g. Brief Project Description: __________ __________
h. Date work is expected to begin: __________
Date work is expected to be completed: __________
i. Total Project Cost: $__________
j. Length of shoreline on the project site:__________
				  feet
k. Length of shoreline at adjacent property owned or
				  controlled by the applicant: __________feet
l. Approximate size of project site within BCDC's "shoreline
				  band" jurisdiction: __________ square feet
m. Approximate size of project site within BCDC's "Bay" or
				  "certain waterway" jurisdiction: __________ square feet
n. Approximate size of project site within BCDC's managed
				  wetland or salt pond jurisdiction: __________ square feet
o. Approximate size of project site within the Suisun Marsh:
				  __________ square feet
p. Approximate size of project site outside of BCDC's
				  jurisdiction __________ square feet
q. Approximate total size of project site (including areas
				  outside BCDC's jurisdiction): __________ square feet
r. Area of total project site reserved for non-public access
				  uses: __________ square feet
s. Area of total project site reserved for public access:
				  __________ square feet
t. Does the project involve development within the primary
				  management area of the Suisun Marsh?
[] Yes
[] No
If "Yes," provide any relevant duck club number(s):
				  __________
u. Project Details. Complete all that apply.
Proposed Elements of the
						  Project
In BCDC's Bay, Certain Waterway,
						  Managed Wetlands or Suisun Marsh
						  Jurisdiction*
In BCDC's Shoreline Band
						  jurisdiction
Outside BCDC's
						  jurisdiction
Totals
1.
Structures
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
2.
All Roads, Parking, Pathways,
						  Sidewalks
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
3.
Number of Parking Spaces:
4.
All
						  Landscaping
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
5.
Left
						  undeveloped
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
6.
Shoreline
						  Protection
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
7.
Piers, docks and other marine-related
						  purposes
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
8.
Areas used for other purposes
						  (specify)
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
Totals:
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
* If project will occur in more than one of
						  these jurisdictions, provide the requested information for each area
						  separately.
v. INFORMATION ABOUT THE TOTAL PROJECT AND SITE (PROVIDE IN
				  AN ATTACHMENT):
1. Provide a detailed project description.
2. Describe the existing condition of the site, including the
				  elevations, underwater topography, vegetation, structures and uses. Provide one
				  or more photographs of existing site conditions.
3. Identify bathymetric features, tidal hydrology and
				  sediment movement at the project site and describe how the project may
				  influence these factors.
4. Endangered or Threatened Species.
a. identify any known threatened or endangered species, or
				  any species that the California Department of Fish and Wildlife or a federal
				  wildlife agency has determined are candidates for listing as threatened or
				  endangered species, or any species that provide substantial public benefits
				  that may be found at the project site.
b. Provide any "take" authorizations issued by the state or
				  federal resource agencies.
c. Provide any "biological opinion" issued by a state or
				  federal agency as the result of an endangered species consultation.
5. Identify any subtidal areas that are scarce or that have
				  an abundance and diversity of fish, other aquatic organisms and wildlife (e.g.,
				  eel grass beds, sandy deep water or underwater pinnacles) at the site. Add the
				  identified areas to the project site plan (see below).
6. Indicate whether the project would involve the release of
				  pollutants or have the potential for accidental pollutant discharge into the
				  Bay. If so, describe how the proposed project has been designed and would be
				  constructed and maintained to prevent or minimize the discharge of pollutants
				  into the Bay, including non-point source pollution (storm water runoff).
				  Provide any storm water pollution prevention plans, when available, storm water
				  management plans, or other water pollution or erosion and sediment control
				  plans showing proposed best management practices developed for the project and
				  the project site.
7. Identify any suspected or known sites of toxic
				  contamination on or in proximity to the project site, and provide the following
				  information: (a) the types of pollutants present; (b) the location of the
				  pollutants (show on the site plan); (c) the extent to which the pollutants are
				  accessible to humans, fish, wildlife or vegetation, or are moving offsite; and
				  (d) steps being taken (including government actions) to control or clean up the
				  pollutants.
8. Provide a copy of any water quality certification or waste
				  discharge requirements that are required by the San Francisco Bay Regional
				  Water Quality Control Board, and any approvals that are required by the State
				  Department of Toxic Substances Control.
9. You must provide information to show that your project
				  would be consistent with the Commission's laws and policies. This application
				  addresses the most common policies raised by most projects. The Commission
				  staff will assist you in identifying additional policies, if any, that apply to
				  your project. Once they are identified, please explain how they offer support
				  for your project and how the project would be consistent with them. The
				  Commission's laws and policies may be found in the digital library at
www.bcdc.ca.gov
.
10. PROJECT PLANS: Provide the following types of plans: (a)
				  vicinity map sized 8.5"x11"; (b) public access and open space exhibit; (c)
				  project site plan reduced to 8.5"x11"; and (d) full-sized project site
				  plan.
PLAN REQUIREMENTS: The public access and open space exhibit
				  must include property boundaries, proposed structures, and an accurate
				  depiction of areas to be provided as public access, open space and view
				  corridors. At a minimum, the project site plan must include property
				  boundaries, all existing and proposed structures and improvements (with cross
				  sections and elevations if necessary), and any tidal marshes and tidal flats.
				  All plans must include a graphic scale, a north arrow, the date and name of the
				  person who prepared the plans, and a depiction of the edge of the Commission's
				  jurisdiction over the Bay or certain waterway (mean high water or, in tidal
				  marshlands, the inland edge of marsh vegetation up to five feet above Mean Sea
				  Level), and the edge of the Commission's shoreline band jurisdiction (100 feet
				  wide measured from the edge of the Bay). See also Appendix F for
				  details.
Box 3 Fill Information
("Fill" means earth or any other substance or material,
				  including pilings or structures placed on pilings, and structures floating at
				  some or all times and moored for extended periods, such as houseboats and
				  floating docks. Gov. Code Section
				  66632(a))
a. Complete this box if fill would be placed in any of these
				  areas (check all those that apply):
[] San Francisco Bay [] Salt pond [] Managed wetland
[] "Certain waterway" [] Primary management area of the
				  Suisun Marsh [] Other: __________
b. Surface area of tidal and subtidal property to be covered
				  with fill: __________ square feet
c. Total volume of solid fill to be placed in tidal and
				  subtidal areas: __________ cubic yard
d. Type of Fill. Surface area of proposed:
Solid fill: __________ square feet
Floating fill: __________ square feet
Pile-supported fill: __________ square feet
Cantilevered fill: __________ square feet
Total area to be filled: __________ square feet
e. Types of Areas to be Filled. Of the total area to be
				  filled, what is the footprint of fill that would be placed in:
Open water: __________ square feet
Tidal marsh: __________ square feet
Tidal flat: __________ square feet
Salt pond: __________ square feet
Managed wetlands in the primary management area of the Suisun
				  Marsh: __________ square feet
Other managed wetlands: __________ square feet
f. Area on new fill to be reserved for:
Private, commercial, or other non-public-access uses:
				  __________ square feet
Public access: __________ square feet
g. INFORMATION REGARDING FILL (PROVIDE IN AN
				  ATTACHMENT):
1. Provide dimensions of portions of all structures to be
				  built on new fill, including length, width, area, height and number of
				  stories.
2. Provide one or more photographs of existing shoreline
				  conditions.
3. Explain the purpose of fill in the Bay, salt pond, managed
				  wetland, certain waterway, or Suisun Marsh considering that the Commission can
				  approve new fill for only five purposes: (a) accommodating a water-oriented
				  use; (b) minor fill for improving shoreline appearance; (c) minor fill for
				  providing new public access to the Bay; (d) accommodating a project that is
				  necessary to the health, safety, or welfare of the public in the entire Bay
				  Area; and (e) accommodating a project in the Suisun Marsh that is consistent
				  with either: (1) the Suisun Marsh Preservation Act and the Suisun Marsh
				  Protection Plan; or (2) the Suisun Marsh Local Protection Program.
4. Explain:
i. what possible impacts the fill would have on the Bay Area,
				  including impacts on: (1) the volume of Bay waters, on Bay surface area, or on
				  the circulation of Bay water; (2) water quality; (3) the fertility of marshes
				  or fish or wildlife resources; and (4) other physical conditions that exist
				  within the area, including land, air, water, minerals, flora, fauna, noise, or
				  objects of historic or aesthetic significance; and
ii. how the nature, location, and extent of the fill would
				  minimize possible harmful conditions or effects to the Bay.
5. For projects in subtidal areas that have an abundance and
				  diversity of fish, other aquatic organisms and wildlife, or are scarce such as
				  eelgrass beds and sandy deep water, identify feasible alternatives and public
				  benefits associated with the project.
6. Explain: (a) why the fill would be the minimum amount
				  necessary; and (b) why there is no alternative upland location for the project
				  that would avoid the need for Bay fill.
7. If the fill is to be used for improving shoreline
				  appearance or providing new public access to the Bay, explain why it is
				  physically impossible or economically infeasible to accomplish these goals
				  without filling the Bay.
8. Explain how the fill would result in a stable and
				  permanent shoreline.
9. Explain the steps that would be taken to assure that the
				  project will provide reasonable protection to persons and property against
				  hazards of unstable geologic or soil conditions, of sea level rise, or of flood
				  or storm waters.
10. Provide the names, addresses, and telephone numbers of
				  any licensed geologists, engineers, or architects involved in the project
				  design who can provide technical information and certify the safety of the
				  project.
11. Describe in detail the anticipated impacts of the fill on
				  the tidal and subtidal environment, and describe how these impacts would be
				  addressed or mitigated, and explain how the public benefits of the project
				  would clearly exceed the public detriment from the loss of water area, tidal
				  marsh or tidal flats.
12. For marina projects, indicate how many berths, if any,
				  are to be made available for live-aboard boats and explain how these
				  live-aboard boats would contribute to public trust purposes.
13. For tidal, subtidal and other wetland restoration
				  projects, including mitigation projects: (a) identify specific long-term and
				  short-term biological and physical goals; (b) identify success criteria; (c)
				  provide a monitoring program intended to assess the success and sustainability
				  of the project; (d) include an adaptive management plan with corrective
				  measures, if needed, to achieve success and sustainability; and (e) identify
				  the provisions for long-term maintenance, as required by the Bay Plan policies
				  on Mitigation, Tidal and Subtidal Areas. The Commission's laws and policies may
				  be found at
www.bcdc.ca.gov
in the digital
				  library.
Box 4 Shoreline Band Information
("Shoreline band" means the land area lying between the Bay
				  shoreline and a line drawn parallel to and 100 feet from the Bay shoreline. The
				  Bay shoreline is the Mean High Water Line, or five feet above Mean Sea Level in
				  marshlands.)
a. Does the project involve development within the 100-foot
				  shoreline band around San Francisco Bay?
[] Yes [] No
If "Yes", complete this box.
b. Types of activities to be undertaken or fill, materials or
				  structures to be placed within the shoreline band:
___________________________
___________________________
___________________________
c. Would the project be located within a priority use area
				  designated in the San Francisco Bay Plan?
[] Yes [] No
The Bay Plan and Maps that depict priority use areas can be
				  viewed in the digital library at
www.bcdc.ca.gov
.
If "No," go to section (d). If "Yes," please indicate which
				  priority use the area is reserved for: __________
Would the project use be consistent with the priority use for
				  which the site is reserved?
[] Yes [] No
If "Yes," go to section (d). If "No," attach an explanation
				  of how the project can be approved despite this inconsistency
d. Total shoreline band area:
Within project site: __________ square feet
To be reserved for private, non-public access uses:
				  __________ square feet
To be reserved for public access: __________ square
				  feet
e. INFORMATION ABOUT WORK PROPOSED IN THE SHORELINE BAND
				  (PROVIDE IN AN ATTACHMENT):
1. Provide dimensions of portions of all structures to be
				  built within the shoreline band, including length, width, area, height, and
				  number of stories.
2. Provide one or more photographs of existing conditions
				  within the 100-foot shoreline band.
Box 5 Public Access Information
(must be completed by all applicants)
a. PUBLIC ACCESS DETAILS:
1. Does public access to the shoreline or do views to the Bay
				  presently exist at the project site, at a contiguous property, or from nearby
				  roads or public access areas?
[] Yes [] No
If "Yes", attach a description of the existing public access
				  and views at these areas.
If "No," explain what is preventing public access to, or
				  views of, the shoreline.
2. Describe how the project would or would not adversely
				  impact present and future public access and views to the Bay. If so, describe
				  how the proposed public access would offset the impact.
3. For most large projects, identify: (1) the existing number
				  of people or employees using the site; and (2) the existing number of cars,
				  bicycles, and pedestrians visiting the site and the level of service of all
				  nearby roads leading to the site. Describe how the project would change these
				  factors.
4. Identify the public's use of existing nearby parks, public
				  access, public parking and other recreational areas on the shoreline and the
				  roads leading to the site and describe the impact the project is expected to
				  have on that use.
5. Do public safety considerations or significant use
				  conflicts make it infeasible to provide new public access to the shoreline on
				  the project site?
[] Yes [] No
If "Yes," describe the public safety considerations or
				  significant use conflicts that make it infeasible to provide public access at
				  the project site and either: (1) identify an offsite area where public access
				  to the shoreline is proposed as part of the project and describe the proposed
				  public access area and improvements at that location; or (2) explain why no
				  offsite public access is proposed as part of the project
6. Dimensions of the public access areas:
[] None Proposed
Existing
Proposed
Total public access area including areas outside BCDC's
						  jurisdiction:
__________ square feet
__________ square
						  feet
Public access within Commission's shoreline band
						  jurisdiction:
__________ square feet
__________ square
						  feet
__________ linear feet
__________
						  linear feet
__________ average width
__________
						  average width
Public access pathways, sidewalks in the shoreline
						  band:
__________ square feet
__________ square feet
__________ linear feet
__________
						  linear feet
__________ average width
__________
						  average width
Public access area, landscaping in the shoreline
						  band:
__________ square feet
__________ square feet
Public access on fill within Commission's Bay, certain
						  waterways, and managed wetlands
__________ square
						  feet
__________ square feet
jurisdiction:
__________ linear
						  feet
__________ linear feet
__________ average width
__________
						  average width
Public access on piers or decks over
						  water/wetlands:
__________ square feet
__________ square
						  feet
__________ linear feet
__________
						  linear feet
__________ average width
__________
						  average width
View corridor(s):
__________ square
						  feet
__________ square feet
__________ linear feet
__________
						  linear feet
__________ average width
__________
						  average width
Public access parking:
__________
						  stalls
__________ stalls
b. ADDITIONAL PUBLIC ACCESS INFORMATION (PROVIDE IN AN
				  ATTACHMENT):
1. Describe the existing and proposed public access
				  improvements, both on-site and off-site, including decks, piers, pathways,
				  sidewalks, signs, benches, landscaping, parking, and any other proposed public
				  improvements.
2. Describe how the public access area and facilities would
				  be accessible to disabled persons.
3. Describe the proposed connections to existing public
				  streets or offsite public pathways.
4. Specify how the public access areas would be permanently
				  guaranteed (e.g., dedication, deed restriction, etc.) and how the areas and
				  improvements would be maintained.
5. Describe the species present, wildlife use, and habitat
				  conditions in and adjacent to the proposed public access areas and the likely
				  type and degree of human use of the site (i.e., bicycling, dog walking,
				  birding, frequency of use, etc.). Describe how any potential adverse effects on
				  wildlife from public access would be avoided or minimized through the siting,
				  design and management of the public access being proposed at the site.
Box 6 Dredging and Mining Information
a. Complete this box if the project involves mining, dredging
				  or the disposal of dredged material in any of the following areas.
[] San Francisco Bay [] Salt pond [] Managed wetland []
				  "Certain waterway"
[] Primary management area of the Suisun Marsh [] Other:
				  __________
b. Are you submitting a separate application to the Dredged
				  Material Management Office (DMMO)?
[] Yes [] No
If "Yes," attach a copy of that application; it is not
				  necessary to complete this Box. If "No," complete this box.
c. Type of activity: [] Maintenance Dredging [] New Dredging
				  [] Mining
___________________________
d. Method of dredging or mining:
___________________________
e. Total volume and area of material to be dredged or mined
				  from:
Open waters: __________ cubic yards __________ square
				  feet
Tidal marshes: __________ cubic yards __________ square
				  feet
Tidal flats: __________ cubic yards __________ square
				  feet
Salt ponds: __________ cubic yards __________ square
				  feet
Managed wetlands in the primary management area of the Suisun
				  Marsh: __________ cubic yards __________ square feet
Other managed wetlands: __________ cubic yards __________
				  square feet
Subtidal areas that are scarce or have an abundance and
				  diversity of fish, other aquatic organisms and wildlife, such as eelgrass beds
				  and sandy deep water. __________ cubic yards __________ square feet
Other (specify): __________ cubic yards __________ square
				  feet
f. Are knockdowns proposed as part of the dredging
				  project?
[] Yes [] No
Number of knockdowns: __________
Volume per knockdown event: __________ cubic yards
g. Location(s) where dredged or mined material will be
				  deposited:
h. Total volume of dredged material to be disposed of:
				  __________ cubic yards
Beneficially re-used: __________ cubic yards
i. Estimated future maintenance dredging required annually:
				  __________ cubic yards
j. For dredging projects:
Proposed design depths (MLLW): (1) __________(2)
				  __________(3) __________
Proposed over-depth dredging (+ feet): (1) __________(2)
				  __________(3) __________
Number of dredging episodes: __________
k. Does this project have an annual average dredging average
				  of 50,000 cubic yards or less? [] Yes [] No
g. ADDITIONAL INFORMATION (PROVIDE IN AN ATTACHMENT):
1. If the dredged material is to be disposed of in the Bay,
				  explain why the material cannot feasibly be beneficially re-used or disposed of
				  in the ocean, upland, or inland outside of the Commission's
				  jurisdiction.
2. Provide the results of testing for biological, chemical or
				  physical properties of the material to be dredged.
3. Provide a copy of a water quality certification or waste
				  discharge requirements for the dredging or disposal of dredged material from
				  the San Francisco Bay Regional Water Quality Control Board.
4. Identify local and Bay-wide effects of the project on: (a)
				  the possible introduction or spread of invasive species; (b) tidal hydrology
				  and sediment movement; (c) fish, other aquatic organisms and wildlife; (d)
				  aquatic vegetation; and (e) the Bay's bathymetry.
5. For projects in subtidal areas that have an abundance and
				  diversity of fish, other aquatic organisms and wildlife, or are scarce such as
				  eelgrass beds and sandy deep water, identify feasible alternatives and public
				  benefits associated with the project.
Box 7 Information on Government Approvals
(must be completed by all applicants)
Required YES
						  NO
Type
						  Approval
Date Approval
						  Expected/Received
Agency Contact and
						  Phone Number
Local
						  Government
Discretionary Approval(s):
[] Yes []
						  No
__________
__________
___________________________
State Lands Commission:
[] Yes []
						  No
__________
__________
___________________________
___________________________
Regional Water Quality Control Board:
[] Yes
						  [] No
__________
__________
___________________________
Regional Board
						  Number:
___________________________
California Dept. of Toxic Substances
						  Control:
[] Yes []
						  No
__________
__________
___________________________
California Department of Fish and Wildlife Streambed
						  Alteration Permit:
[] Yes []
						  No
__________
__________
___________________________
DF&W Take Authorization:
[] Yes []
						  No
__________
__________
___________________________
Other DF&W Permit:
[] Yes []
						  No
__________
__________
___________________________
U.S. Army Corps Of Engineers:
[] Yes []
						  No
__________
__________
___________________________
Public Notice
						  Number:
___________________________
U.S. Fish and Wildlife Service:
Take Authorization
[] Yes []
						  No
__________
__________
___________________________
Biological Opinion:
[] Yes []
						  No
__________
__________
___________________________
NOAA Fisheries Service:
Take Authorization
[] Yes []
						  No
__________
__________
___________________________
Biological Opinion
[] Yes []
						  No
__________
__________
___________________________
U.S. Coast Guard:
[] Yes []
						  No
__________
__________
___________________________
Federal Funding:
[] Yes []
						  No
__________
__________
___________________________
Other Approval (Specify):
__________
__________
___________________________
Box 8 Environmental Impact Documentation
(must be completed by all applicants)
a. Is the project statutorily or categorically exempt from
				  the need to prepare any environmental documentation?
[] Yes [] No
If "Yes," please attach a statement that identifies and
				  supports this statutory or categorical exemption.
b. Has a government agency other than BCDC, serving as the
				  lead agency, adopted a negative declaration or certified an environmental
				  impact report or environmental impact statement on the project?
[] Yes [] No
If "Yes," attach a copy of the document. If the environmental
				  impact report or statement is longer than ten pages, also provide a summary of
				  up to ten pages. If "No," provide sufficient information to allow the
				  Commission to make the necessary findings regarding all applicable policies.
				  The certified document must be submitted prior to action on the permit.
Box 9 Public Notice Information
(must be completed by all applicants)
a. Owners and residents of all properties located within 100
				  feet of the project site (if more than four, provide the information
				  electronically):
North:
Name: __________ __________
Address: __________ __________
City, State, Zip: __________ __________
Telephone: __________/__________ __________/__________
South:
Name: __________ __________
Address: __________ __________
City, State, Zip: __________ __________
Telephone: __________/__________ __________/__________
East:
Name: __________ __________
Address: __________ __________
City, State, Zip: __________ __________
Telephone: __________/__________ __________/__________
West:
Name: __________ __________
Address: __________ __________
City, State, Zip: __________ __________
Telephone: __________/__________ __________/__________
b. Other persons known to be interested in this project: (if
				  more than two, provide the information electronically). [] None
Name: ____________________
Address: __________ __________
City, State, Zip: __________ __________
Telephone: __________/__________ __________/__________
Name: __________ __________
Address: __________ __________
City, State, Zip: __________ __________
Telephone: __________/__________ __________/__________
Checklist of Application Requirements
(For Applicant's Use)
Major
						  Permit
Administrative
						  Permit
Regionwide
						  Permit
[]
Application Form
One fully
						  completed and signed original and seven copies
One fully completed and
						  signed original
One fully completed and signed original
[]
Large Scale Project Site Plan
One
						  copy
One copy
One copy
[]
8.5"x11" Project Site Plan
Seven
						  copies
One copy
One copy
[]
*8.5"x11" Public Access and Open Space
						  Plan
Seven copies
One copy
None
[]
8.5"x11" Vicinity Map
Seven
						  copies
One copy
One copy
[]
Proof of Legal Property
						  Interest
One copy
One copy
One copy
[]
Local Government Discretionary
						  Approval
One copy
One copy
None
[]
Environmental Documentation
One
						  copy of environmental determination and EIR or EIS Summary
One copy of
						  environmental determination
None
[]
Water Quality
						  Certification/Waiver
One copy, if applicable
One copy, if
						  applicable
One copy, if applicable
[]
Dept. of Toxic Substances Control
						  Approval
One copy, if applicable
One copy, if
						  applicable
One copy, if applicable
[]
Biological Opinion/Take Authorization from
						  state and federal agencies
One copy, if applicable
One copy, if
						  applicable
[]
Application Processing Fee
As
						  specified in Commission regulations, Appendix M
As specified in
						  Commission regulations, Appendix M
As specified in Commission
						  regulations, Appendix M
[]
*Notice of Pending
						  Application
Posted at project site
Posted at project
						  site
Posted at project site
[]
*Certification of Posting the Notice of
						  Application
One signed original returned to BCDC
One signed
						  original returned to BCDC
One signed original returned to BCDC
* BCDC staff will provide the forms for
						  posting the Notice of Application and the Certification.
The provisions of this form are self-explanatory and no other
				  instructions are applicable.
1. New
				  Appendix D filed 5-18-87; operative 6-17-87 (Register 87, No.
				  30).
2. Amendment of appendix and new NOTE filed 2-2-98; operative
				  3-4-98 (Register 98, No. 6).
3. Amendment of appendix and NOTE filed
				  7-11-2000; operative 7-11-2000 (Register 2000, No. 28).
4. Repealer
				  and new Appendix D filed 9-11-2008; operative 10-11-2008 (Register 2008, No.
				  37).
5. Change without regulatory effect amending and relocating
				  Appendix D from chapter 17 to chapter 24 filed 12-31-2020 pursuant to section
				  100, title 1, California Code of
				  Regulations (Register 2021, No. 1). (OAL review extended 60 calendar days
				  pursuant to Executive Order N-40-20.)
Note: Authority cited: Sections
					 66632,
					 Government Code; and Section
					 29201(e),
					 Public Resources Code. Reference: Sections
					 65940-
					 65942,
					 66605,
					 66632(b),
					 66632(f)
					 and
					 84308,
					 Government Code; Sections
					 2770,
					 2774,
					 21080.5,
					 21082,
					 21160
					 and
					 29520,
					 Public Resources Code; and the San Francisco Bay
					 Plan.