California Code of Regulations › Title 14 - Natural Resources › Division 5 - San Francisco Bay Conservation and Development Commission › Appendices › Appendix N - Application Checklist

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Abbreviated Regionwide
						  Permit
[] Abbreviated Application Form:
One
						  fully completed and signed original
[] Large Scale Project Site Plan
One
						  Copy
[] 8 1/2" x 11" Project Site
						  Plan
One Copy
[] 8 1/2" x 11" Vicinity Map
One
						  Copy
[] Proof of Legal Interest
One
						  Copy
[] Permit Processing Fee
As
						  Specified in Appendix M
__________
*Additional drawings are needed for projects that are
				  evaluated by the Commission's Design Review Board or Engineering Criteria
				  Review Board.
Application Information
Box 1 Applicant Information
a. PROPERTY OWNER: [] Individual [] Private Entity []
				  Government [] Non-profit
Name: ___________________________
Address: ___________________________
City, State, Zip: ___________________________
Telephones: ___________________________
b. OWNER'S REPRESENTATIVE: [] None
Name: ___________________________
Address: ___________________________
City, State, Zip: ___________________________
Telephones: ___________________________
Affiliation to Applicant: ___________________________
I hereby authorize
___________________________
to act as my representative and bind me in all
				  matters concerning this application.
___________________________
Signature of Owner
Date
___________________________
Printed Name of Owner
c. APPLICANT: [] Individual [] Private Entity [] Government
				  [] Non-profit
Name: ___________________________
Address: ___________________________
City, State, Zip: ___________________________
Telephones: ___________________________
d. APPLICANT'S REPRESENTATIVE: [] None
Name: ___________________________
Address: ___________________________
City, State, Zip: ___________________________
Telephones: __________/__________/__________
Affiliation to Applicant: ___________________________
I hereby authorize
___________________________
to act as my representative and bind me in all
				  matters concerning this application.
___________________________
Signature of Applicant
Date
___________________________
Printed Name of Applicant
e. Co-APPLICANT: [] None [] Individual [] Private Entity []
				  Government [] Non-profit
Name: ___________________________
Address: ___________________________
City, State, Zip: ___________________________
Telephones: __________/__________/__________
f. CO-APPLICANT'S REPRESENTATIVE:
None
Name: ___________________________
Address: ___________________________
City, State, Zip: ___________________________
Telephones: __________/__________/__________
Affiliation to Applicant: ___________________________
I hereby authorize
___________________________
to act as my representative and bind me in all
				  matters concerning this application.
___________________________
Signature of Applicant
Date
___________________________
Printed Name of Applicant
Box 2 Certification of Accuracy of
				  Information
I hereby certify under penalty of perjury that to the
				  best of my knowledge the information in both Part 1 and Part II of 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.
___________________________
Signature of Owner or Date
Owner's Representative
___________________________
Signature of Applicant or Date
Applicant's Representative
___________________________
Signature of Co-Applicant or Date
Co-Applicant's Representative
Box 3 Project Information
a. Project Name: ___________________________
b. Project Description: ___________________________
___________________________
___________________________
c. Date work is expected to begin:
				  ___________________________
Date work is expected to be completed:
				  ___________________________
d. Does the project involve the placement of fill of ant type
				  in San Francisco Bay or within a salt pond, a managed wetland, or a certain
				  waterway?
[] YES [] NO
If "Yes", completed Box 5.
e. Does the project involve development within the shoreline
				  band around San Francisco Bay?
[] YES [] NO
If "Yes", complete Box 6.
f. Total Project Cost: $____________________
Box 4 Site Information
a. Street Address: ___________________________
b. City, County, State, Zip:
				  ___________________________
c. Assessor's Parcel: ______________________________
Numbers: ______________________________
[] None
d. ID number(s) of previous BCDC permit(s) issued for work on
				  this site: ______________________________
[] None
e. Provide a brief description of the existing condition of
				  the site, including the present elevations, current vegetation, existing
				  structure and use of the site.
Box 5 Bay 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. Cal. Gov. Code Section
				  66632(a))
a. What is the basic purpose of the new fill in the
				  Bay?
___________________________
___________________________
b. Total volume of water, marsh, or salt pond to be filled:
				  __________ cubic yards
c. Area to be covered with solid fill: __________ square
				  feet
d. Area to be covered with floating fill: __________ square
				  feet
e. Area to be covered with pile-supported fill: __________
				  square feet
f. Area to be covered with cantilevered fill: __________
				  square feet
g. Area to be covered with any other type of fill:
(Specify type of fill):
__________ square feet
h. Total area to be filled: __________ square feet
Box 6 Shoreline Band Information
("Shoreline band" means "...all territory location between
				  the shoreline of San Francisco Bay...and a line 100 feet landward of and
				  parallel with that Line..." Cal.Gov.Code Section
				  66610(b))
a. Types of activities to be undertaken or materials to be
				  placed along the shoreline:
___________________________
___________________________
b. Will the project be located within a water-oriented
				  priority use area that is designated in the San Francisco Bay Plan?
[] YES [] NO
If "No," go to section (c).
If "Yes," indicated which priority use the area is reserved
				  for:
___________________________
Will the project use be consistent with the priority use for
				  which the site is reserved?
[] YES [] NO
If "Yes," go to section (c).
If "No," attach an explanation of how the project can be
				  approved despite this inconsistency.
c. Provide dimensions of portions of all structures to be
				  built within the shoreline band, including length, width, area, height, and
				  number of stories:
___________________________
___________________________
___________________________
___________________________
1. New
				  Appendix N filed 8-6-96; operative 9-5-96 (Register 96, No. 32).
2.
				  Amendment of application checklist and new NOTE filed 10-14-2004; operative
				  10-14-2004 pursuant to Government Code section
				  11343.4
				  (Register 2004, No. 42).
3. Change without regulatory effect
				  amending and relocating Appendix N from chapter 17 to chapter 240 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: Section
					 66632,
					 Government Code; and Section
					 29201(e),
					 Public Resources Code. Reference: Sections
					 65940-
					 65942,
					 66632(b),
					 66632(f)
					 and
					 84308,
					 Government Code; Sections
					 21080.5,
					 21082
					 and
					 29520,
					 Public Resources Code; and San Francisco Bay
					 Plan.