Fillable Form 95453: COUNTY OF LAKE WATER RESOURCES DEPARTMENT (County of Lake)

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Form 95453: COUNTY OF LAKE WATER RESOURCES DEPARTMENT (County of Lake)

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The Form 95453: COUNTY OF LAKE WATER RESOURCES DEPARTMENT (County of Lake) form is 7 pages long and contains:

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BROWSE COUNTY OF LAKE (CA) FORMS

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APPLICATION FOR
LAKEBED ENCROACHMENT PERMIT
Assessor’s Parcel No.: _____________________ Date: __________________
Site Address: __________________________________ City: _______________________________
State: _____ Zip Code: _____________ E-mail ________________________________________
Property Owner: _____________________ Phone Number:________________________________
Mailing Address _______________________________ City: __________________________________
State: ________ Zip Code: ____________ E-mail: __________________________________________
Contractor: _________________________ Phone Number:___________________________________
Address: _____________________________________ City: __________________________________
State: ______ Zip Code: ____________ E-mail: ____________________________________________
Is there restricted access?(gate, dog, etc.):_______________________________________________
Please provide written explanation on spaces provided below, as well as: Site Plans, Map(s) and
Payment (check or money order only) upon submission of Encroachment Permit Application***
Project Description:
Additional Information/ Notes:
COUNTY OF LAKE
WATER RESOURCES DEPARTMENT
255 N. Forbes Street
Lakeport, California
95453
Telephone: 707-263-2344
Fax: 707-263-1965
water.resources@lakecountyca.gov
Scott DeLeon
Public Works Director
W:\Lakebed\Encroachments\Encroachment Permit Documents\Lakebed Encroachment Permit Application 7.19
Lakebed E
ncroachment Permit– Supplemental Environmental Questionnaire
Background.
The completed Supplemental Environmental Questionnaire is required during the submission of a
Lakebed Encroachment Permit. The Questionnaire is used for all projects that will result in disturbance to
the lakebed, including but not limited to alterations that are within the nearshore or foreshore.
Definitions.
*Fish Spawning Areas / Fish Aquatic
Habitats
Areas which have been, prior to the issuance of the administrative
encroachment permit, designated as such by the County of Lake or by
State or Federal fish and game authorities, or such other areas
determined by Lakebed Management to contain fish spawning areas
or fish and aquatic habitats of sufficient magnitude, environmental
importance, or uniqueness to warrant denial of an application for
construction, alteration, or use.
*Foreshore
Zone lying between the low water mark (0.00 feet Rumsey) and the
high water mark (7.79 feet Rumsey). This zone is also the area of the
Public Trust Easement that is defined in "Lyon v. State of California,
29 Cal. 3d 210."
*Nearshore
Zone extending lakeward from the low water mark.
Project Area
Area where construction activities will occur, including; areas required
for equipment access, and 25 foot area around the proposed structure
or repair identified in the Lakebed Encroachment Permit.
*Shoreline
Line established by Clear Lake when its level is at zero (0.00) feet on
the Rumsey Gauge.
*Shorezone
Area composed of the nearshore, foreshore, and backshore.
*Wetlands
Areas that are inundated or saturated by surface or groundwater at a
frequency and duration sufficient to support, and that under normal
circumstances do support, a prevalence of vegetation typically
adapted for life in saturated soil conditions. Wetlands generally
include swamps, bogs, marshes, and similar areas
*indicates definitions identified in Ch.23-3 of County Code of Ordinances
Instructions.
Complete all sections below. Where indicated, provide additional information in the box. If additional
sheets are required, attach to this questionnaire. Please reference the section and section number on the
additional sheet(s). If a section number is not applicable to the project, check “N/A”.
COUNTY OF LAKE
WATER RESOURCES DEPARTMENT
255 N. Forbes Street
Lakeport, California 95453
Telephone (707) 263-2344
Fax (707) 263-1965
Scott De Leon
Water Resources Director
COUNTY OF LAKE WATER RESOURCES DEPARTMENT
Lakebed Encroachment Permit– Supplemental Environmental Questionnaire Permit Number: __________
(Version Date: 20190418 - DRAFT) Page 1 of 4
Project Components.
a. Pl
ease check which of the following best describes the proposed project. All aspects of the
proposed project should be indicated. For each project component, complete
Project Component
Check for Yes
Seawall or Bank Stabilization
Pier, Dock, or Floating Structure
Buoy
Cable or pipeline
Beach Clearing
Dredging
Ge
neral Information.
a. Will construction activities be conducted between October 15 and December 31? If no, please
provide an approximate timeframe for the construction.
Yes
No
En
vironment/Land Characteristics.
a. Pl
ease check all of the following that describe the project area and surrounding area.
Terrestrial Features
Description
Present
Seawall or Riprap
Cliffs
Maintained Lawn
Grassland or Pasture
Bushes or Shrubs
Large Trees (DBH <12”)
Aquatic Features
Description
Present
Marsh or Wetland
Beach Sand
Mud Flat
Gravel or Rock Bottom
Tules, Reeds, or Rushes
Submerged or Floating Vegetation
Large Rocks
COUNTY OF LAKE WATER RESOURCES DEPARTMENT
Lakebed Encroachment Permit– Supplemental Environmental Questionnaire Permit Number: __________
(Version Date: 20190418 - DRAFT) Page 2 of 4
Potential for impacts within the project area will be evaluated for the following:
Ve
getation
a. Will t
errestrial vegetation be removed within the project area? If yes, describe the type of
vegetation (i.e., species if possible) and the approximate amount of vegetation to be removed. Do
not include blackberries, ornamental plants, or maintained lawns.
Yes
No
b.
Is habitat present? If yes, describe the habitat and measures to protect resource. Habitat may
include aquatic vegetation such as tules or terrestrial vegetation such as trees used for nesting.
Yes
No
Wildlife
a. Ar
e raptors or nesting birds present or typically present within or adjacent to the project area?
Yes
No
b. Wi
ll the project result in a barrier to the migration or movement of animals? If yes, describe the
nature of the barrier.
Yes
No
COUNTY OF LAKE WATER RESOURCES DEPARTMENT
Lakebed Encroachment Permit– Supplemental Environmental Questionnaire Permit Number: __________
(Version Date: 20190418 - DRAFT) Page 3 of 4
Land
a) W
ill the project require dredging, grading, removal of material, or filling of land in or adjacent t
o
Clear Lake? If yes, explain. Include the approximate quantity of material to be removed and a
des
cription of where spoils will be placed.
Yes
No
b) Will the project result in unstable soil conditions during or after completion of the project?
Yes
No
c) I
f project components include seawall or bank stabilization, will the project change the topography
or ground surface that is inconsistent with the natural surrounding conditions?
Yes
No N/A
d) If project components include pier, dock, or floating structure, will the project connect to the
s
hore? If yes, describe the connection (for example, seawall, concrete landing, natural ground)?
Yes
No N/A
Water Quality
a) W
ill the project result in alteration of water quality, including but not limited to temperature or
turbidity? If yes, describe the alteration to the water quality.
Yes
No
COUNTY OF LAKE WATER RESOURCES DEPARTMENT
Lakebed Encroachment Permit– Supplemental Environmental Questionnaire Permit Number: __________
(Version Date: 20190418 - DRAFT) Page 4 of 4
b) Will the project result in discharge into surface waters? If yes, describe the type of discharge and
quan
tity of discharge (if applicable).
Yes
No
c) D
oes the project include facilities for the storage and/or dispensing of gasoline, oil,
paint/stain/varnish, or other such materials? If yes, describe the facility and the type of
material(s).
Yes
No
d) I
f project components include seawall or bank stabilization, will the project result in substantial
alteration to storm water drainage? If yes, describe alteration to the storm water drainage.
Yes
No N/A
e) I
f project components include a pier, dock, or floating structure, will the foundation of the project
be 90 percent open to the free circulation of water?
Yes
No N/A
S
ignature of Owner or Authorized Agent
Name: _______________________________________
Title: _______________________________________
Company: _______________________________________
____
_____________________________________________
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Form 95453: COUNTY OF LAKE WATER RESOURCES DEPARTMENT (County of Lake)

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Completed 13 February 2021

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