A street or highway location map with road directions to the site from the nearest main highway or road. Assessor map that contains the riparian uplands. Do not mark on this map. A separate drawing to a scale of 1 inch = 100 feet of all existing and proposed structures and/or work. Label each separate activity type stated in Section 3 and show the dimensions of each area by length and width, as stated in Section 3. A legal description of the requested authorization area (s) with an accurate delineation of the area relative to the tax lot boundaries of the upland parcel. (The department may require a survey for this purpose). Project schedule including beginning and completion. Project Budget, itemized including use of requested funds and contributing match funds. Any and All Work Plan or Operation & Maintenance plans that have been prepared for proposed activities. Confirmation of contributing match. Mail application with information in this section to: Oregon Department of State Lands 775 Summer St. NE Ste 100 Salem, OR 97301-1279 9- APPLICANT SIGNATURE I hereby request $ in funding for this project. Application is hereby made for the activities described herein. I certify that I am familiar with the information contained in the application, and, to the best of my knowledge and belief, this information is true, complete, and accurate. I further certify that I possess the authority to undertake the proposed activities. I understand that the granting of other permits by local, county, state or federal agencies does not release me from the requirement of obtaining the authorization requested before commencing the project. I understand that payment of the required state application fee does not guarantee authorization. Print /Type Name Title ______________________________________________ ______________________ Authorized Signature Date I appoint the person named below to act as my duly authorized agent. ____________ Signature Date Print /Type Name Title ____________ Authorized Agent Signature Date
A street or highway location map with road directions to the site from the nearest main highway or road. Assessor map that contains the riparian uplands. Do not mark on this map. A separate drawing to a scale of 1 inch = 100 feet of all existing and proposed structures and/or work. Label each separate activity type stated in Section 3 and show the dimensions of each area by length and width, as stated in Section 3. A legal description of the requested authorization area (s) with an accurate delineation of the area relative to the tax lot boundaries of the upland parcel. (The department may require a survey for this purpose). Project schedule including beginning and completion. Project Budget, itemized including use of requested funds and contributing match funds. Any and All Work Plan or Operation & Maintenance plans that have been prepared for proposed activities. Confirmation of contributing match. Mail application with information in this section to: Oregon Department of State Lands 775 Summer St. NE Ste 100 Salem, OR 97301-1279 9- APPLICANT SIGNATURE I hereby request $ in funding for this project. Application is hereby made for the activities described herein. I certify that I am familiar with the information contained in the application, and, to the best of my knowledge and belief, this information is true, complete, and accurate. I further certify that I possess the authority to undertake the proposed activities. I understand that the granting of other permits by local, county, state or federal agencies does not release me from the requirement of obtaining the authorization requested before commencing the project. I understand that payment of the required state application fee does not guarantee authorization. Print /Type Name Title ______________________________________________ ______________________ Authorized Signature Date I appoint the person named below to act as my duly authorized agent. ____________ Signature Date Print /Type Name Title ____________ Authorized Agent Signature Date
Submerged_Enhancement_Fund_Grant_Application.docx