FORM L&WD-2/PERMIT APPLICATION 8. Date activity is proposed to start , be completed 9. Classification of minor or major permit. Check one: ❑Minor Permit Application Major Permit Application State below which criterion applies in making above check. 10. Application is hereby made for a permit to authorize the activities described herein. I agree to provide any additional information/data that may be necessary to provide reasonable assurance or evidence to show that the proposed project will comply with the applicable territorial water quality standards or other environmental protection standards both during construction and after the project is completed. I also agree to provide entry to the project site for inspectors from the environmental protection agencies for the purpose of making inspection regarding this applicaton and that to the best of my knowledge and belief, that such information provided herein, is true, complete and accurate. I further certify that I possess the authority to undertake the proposed activities. Signature of Applicant or Agent Date Signature of Owner (Where Applicant or Agent is not Owner) FOR DEPARTMENT USE ONLY Inspector Record Date Inspected: ( )Permit Approved ( )Permit Disapproved Inspector's Remarks: Inspector Date Commissioner, Planning & Natural Resources Date EFTA00802930