Sample Joint Application - Idaho

JOINT APPLICATION FOR PERMITS
U.S. ARMY CORPS OF ENGINEERS - IDAHO DEPARTMENT OF WATER RESOURCES - IDAHO DEPARTMENT OF LANDS
Authorities: The Department of Army Corps of Engineers (Corps), Idaho Department of Water Resources (IDWR), and Idaho Department of Lands (IDL) established a joint
process for activities impacting jurisdictional waterways that require review and/or approval of both the Corps and State of Idaho. Department of Army permits are required by
Section 10 of the Rivers & Harbors Act of 1899 for any structure(s) or work in or affecting navigable waters of the United States and by Section 404 of the Clean Water Act for
the discharge of dredged or fill materials into waters of the United States, including adjacent wetlands. State permits are required under the State of Idaho, Stream Protection
Act (Title 42, Chapter 38, Idaho Code and Lake Protection Act (Section 58, Chapter 13 et seq., Idaho Code). In addition the information will be used to determine compliance
with Section 401 of the Clean Water Act by the appropriate State, Tribal or Federal entity.
Joint Application: Information provided on this application will be used in evaluating the proposed activities. Disclosure of requested information is voluntary. Failure to supply
the requested information may delay processing and issuance of the appropriate permit or authorization. Applicant will need to send a completed application, along with
one (1) set of legible, black and white (8½”x11”), reproducible drawings that illustrate the location and character of the proposed project / activities to both the
Corps and the State of Idaho.
See Instruction Guide for assistance with Application. Accurate submission of requested information can prevent delays in reviewing and permitting your application.
Drawings including vicinity maps, plan-view and section-view drawings must be submitted on 8-1/2 x 11 papers.
Do not start work until you have received all required permits from both the Corps and the State of Idaho
FOR AGENCY USE ONLY

Date Returned:

USACE
NWW-

Date Received:

Idaho Department of Water Resources
No.

Date Received:

Fee Received
DATE:

Receipt No.:

Idaho Department of Lands
No.

Date Received:

Fee Received

Receipt No.:

Incomplete Application Returned

DATE:
INCOMPLETE APPLICANTS MAY NOT BE PROCESSED

1. CONTACT INFORMATION - APPLICANT Required:

2. CONTACT INFORMATION - AGENT:

Name:

Name:

Company:

Company:

Mailing Address:

Mailing Address:

City:

State:

Phone Number (include area code):

Zip Code:

City:

State:

Phone Number (include area code):

E-mail:

Zip Code:

E-mail:

4. PROJECT STREET ADDRESS:

3. PROJECT NAME or TITLE:
5. PROJECT COUNTY:

6. PROJECT CITY:

7. PROJECT ZIP CODE:

8. NEAREST WATERWAY/WATERBODY:

9. TAX PARCEL ID#:

10. LATITUDE:

11a. 1/4: 11b. 1/4:

11d. TOWNSHIP:

11c. SECTION:

11e. RANGE:

LONGITUDE:
12a. ESTIMATED START DATE:

13a. IS PROJECT LOCATED WITHIN ESTABLISHED TRIBAL RESERVATION BOUNDARIES?

12b. ESTIMATED END DATE:

NO
13b. IS PROJECT LOCATED IN LISTED ESA AREA?

NO

YES

Tribe:

13c. IS PROJECT LOCATED ON/NEAR HISTORICAL SITE?

YES

NO

YES

14. DIRECTIONS TO PROJECT SITE: Include vicinity map with legible crossroads, street numbers, names, landmarks.

15. PURPOSE and NEED:

Commercial

Industrial

Public

Private

Other

Describe the reason or purpose of your project; include a brief description of the overall project. Continue to Block 16 to detail each work activity and overall project.

NWW Form 1145-1/IDWR 3804-B

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16. DETAILED DESCRIPTION OF EACH ACTIVITY WITHIN OVERALL PROJECT. Specifically indicate portions that take place within waters of the United States, including wetlands: Include
dimensions; equipment, construction, methods; erosion, sediment and turbidity controls; hydrological changes: general stream/surface water flows, estimated winter/summer flows; borrow
sources, disposal locations etc.:

17. DESCRIBE ALTERNATIVES CONSIDERED to AVOID or MEASURES TAKEN to MINIMIZE and/ or COMPENSATE for IMPACTS to WATERS of the UNITED STATES, INCLUDING
WETLANDS: See Instruction Guide for specific details.

18. PROPOSED MITIGATION STATEMENT or PLAN: If you believe a mitigation plan is not needed, provide a statement and your reasoning why a mitigation plan is NOT required. Or, attach a
copy of your proposed mitigation plan.

19. TYPE and QUANTITY of MATERIAL(S) to be discharged below the ordinary high water
mark and/or wetlands:

20. TYPE and QUANTITY of impacts to waters of the United States, including wetlands:

Dirt or Topsoil:

cubic yards

Filling:

acres

sq ft.

cubic yards

Dredged Material:

cubic yards

Backfill & Bedding:

acres

sq ft.

cubic yards

Clean Sand:

cubic yards

Land Clearing:

acres

sq ft.

cubic yards

Clay:

cubic yards

Dredging:

acres

sq ft.

cubic yards

Gravel, Rock, or Stone:

cubic yards

Flooding:

acres

sq ft.

cubic yards

Concrete:

cubic yards

Excavation:

acres

sq ft.

cubic yards

Draining:

acres

sq ft.

cubic yards

:

acres

sq ft.

cubic yards

Other (describe):

:

cubic yards

Other (describe:

:

cubic yards

TOTAL:
NWW Form 1145-1/IDWR 3804-B

cubic yards

Other:

TOTALS:

acres

sq ft.

cubic yards
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21. HAVE ANY WORK ACTIVITIES STARTED ON THIS PROJECT?

NO

YES

If yes, describe ALL work that has occurred including dates.

22. LIST ALL PREVIOUSLY ISSUED PERMIT AUTHORIZATIONS:

23.

YES, Alteration(s) are located on Public Trust Lands, Administered by Idaho Department of Lands

24. SIZE AND FLOW CAPACITY OF BRIDGE/CULVERT and DRAINAGE AREA SERVED:

Square Miles

NO
YES If yes, contact the floodplain administrator in the local government jsrisdiction in which the project is
25. IS PROJECT LOCATED IN A MAPPED FLOODWAY?
located. A Floodplain Development permit and a No-rise Certification may be required.
26a WATER QUALITY CERTIFICATION: Pursuant to the Clean Water Act, anyone who wishes to discharge dredge or fill material into the waters of the United States, either on private or public
property, must obtain a Section 401 Water Quality Certification (WQC) from the appropriate water quality certifying government entity.
See Instruction Guide for further clarification and all contact information.
The following information is requested by IDEQ and/or EPA concerning the proposed impacts to water quality and anti-degradation:
NO
YES Is applicant willing to assume that the affected waterbody is high quality?
NO
YES Does applicant have water quality data relevant to determining whether the affected waterbody is high quality or not?
NO
YES Is the applicant willing to collect the data needed to determine whether the affected waterbody is high quality or not?
26b. BEST MANAGEMENT PRACTICTES (BMP's): List the Best Management Practices and describe these practices that you will use to minimize impacts on water quality and anti-degradation
of water quality. All feasible alternatives should be considered - treatment or otherwise. Select an alternative which will minimize degrading water quality

Through the 401 Certification process, water quality certification will stipulate minimum management practices needed to prevent degradation.
27. LIST EACH IMPACT to stream, river, lake, reservoir, including shoreline: Attach site map with each impact location.
Name of Water Body

Activity

Intermittent
Perennial

Description of Impact
and Dimensions

Impact Length
Linear Feet

TOTAL STREAM IMPACTS (Linear Feet):
28. LIST EACH WETLAND IMPACT include mechanized clearing, filL excavation, flood, drainage, etc. Attach site map with each impact location.
Activity

Wetland Type:
Emergent, Forested, Scrub/Shrub

Distance to
Water Body
(linear ft)

Description of Impact
Purpose: road crossing, compound, culvert, etc.

Impact Length
(acres, square ft
linear ft

TOTAL WETLAND IMPACTS (Square Feet):
NWW Form 1145-1/IDWR 3804-B

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29. ADJACENT PROPERTY OWNERS NOTIFICATION REQUIREM: Provide contact information of ALL adjacent property owners below.

Name:

Name:

Mailing Address:

Mailing Address:

City:

State:

Phone Number (include area code):

Zip Code:

City:
Phone Number (include area code):

E-mail:

Name:

Name:

Mailing Address:

Mailing Address:

City:

State:

Phone Number (include area code):

Zip Code:

Name:

Name:

Mailing Address:

Mailing Address:

City:

State:

Phone Number (include area code):

Zip Code:

Name:

Name:

Mailing Address:

Mailing Address:

City:

State:

Phone Number (include area code):

E-mail:

Zip Code:

Zip Code:

State:

Zip Code:

State:

Zip Code:

E-mail:

City:
Phone Number (include area code):

State:
E-mail:

City:
Phone Number (include area code):

E-mail:

Zip Code:

E-mail:

City:
Phone Number (include area code):

E-mail:

State:

E-mail:

30. SIGNATURES: STATEMENT OF AUTHORIAZATION / CERTIFICATION OF AGENT / ACCESS
Application is hereby made for permit, or permits, to authorize the work described in this application and all supporting documentation. I certify that the
information in this application is complete and accurate. I further certify that I possess the authority to undertake the work described herein; or am acting
as the duly authorized agent of the applicant (Block 2). I hereby grant the agencies to which this application is made, the right to access/come upon the
above-described location(s) to inspect the proposed and completed work/activities.

Signature of Applicant: ___________________________________________________

Date: _______________________

Signature of Agent: ____________________________________________________

Date: _______________________

This application must be signed by the person who desires to undertake the proposed activity AND signed by a duly authorized agent (see Block 1, 2,
30). Further, 18 USC Section 1001 provides that: “Whoever, in any manner within the jurisdiction of any department of the United States knowingly and
willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious, or fraudulent statements or
representations or makes or uses any false writing or document knowing same to contain any false, fictitious or fraudulent statements or entry, shall be
fined not more than $10,000 or imprisoned not more than five years or both”.
NWW Form 1145-1/IDWR 3804-B

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