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GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENTOF PLANNING AND NATURAL RESOURCES DEVELOPMENT PERMIT APPLICATION FORM L&WD-1 DRAFT OF APPLICATION LETTER DATE: FILE: COMMISSIONER DEPARTMENT OF PLANNING AND NATURAL RESOURCES 8100 LINDBERG BAY, STE #61 CYRIL E. KING AIRPORT TERMINAL, SECOND FLOOR ST. THOMAS, US VIRGIN ISLANDS 00802 Dear Commissioner: The undersigned wishes to make application to the Virgin Islands Government and the Secretary to the Army for a Coastal Zone Permit to (State kind of work proposed) in (Give name of waterway) at or near (give location) The (mention proposed work) will be located approximately (give distance and bearing from nearest town, pier, wharf, bridge or any well-known object or establishment monument nearby) and will be (give length, width, height, depth of water at mean low water level, class of construction, is permanent or temporary) within the corporate limits of (state if the work is within the corporate limits of a municipality as shown the accompanying plans) . It is understood that your approval of (mention proposed work) must be first obtained by virtue of the authority vested in you by Act No. 4248 of the Virgin Islands Code. Your favorable endorsement is, therefore, respectfully requested. It is further requested that this letter be considered as an application for the Department of the Army Permit and that it be forwarded with your endorsement thereon to the area Engineer, San Juan Area, US Army Corps of Engineers, 400 Fernandez, Juncos Avenue, SAN JUAN PUERTO RICO 00901 for consideration. Early advice concerning your decision and also concerning the decision of the Department of the Army in the manner will be appreciated. (Signature of Applicant) Official Title, if a Corporation SIGN GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF PLANNING AND NATURAL RESOURCES DEVELOPMENT PERMIT APPLICATION FORM L&WD-2 PERMIT APPLICATION Date Received: Date Declared Complete: Permit Application No. Application is hereby made for an  Earth Change  Coastal Zone Permit 1. Name, mailing address, email address and telephone number of Applicant (person/entity with legal interest in the property, to which permit will be issued) 2. Name, title, mailing address and telephone number of Owner of property and Agent (if any) Owner of Property(s) Agent 3. Location of activity. Plot No. PIN No. Estate Island 4. Zoning District 4.a State type of Land Uses as specified in the VI Zoning Law, which are applied for (e.g., restaurant, hotel, single-family dwelling, etc.) 5. Name, mailing address, email and telephone number of project designer. 6. Summary of proposed activity. Include all incidental improvements such as utilities, roads, etc. (Use additional sheets if necessary). FORM L&WD-2/PERMIT APPLICATION CONT'D 7. Date activity is proposed to start ; be completed 8. Classification of minor or major permit. Check one:  Minor Permit Application  Major Permit Application State below which criterion applies in making above check. 9. 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 provide entry to the project site for inspectors from the environmental protection agencies for the purpose of making inspection regarding this application 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 (if not owner) Date Sign Print Signature of Owner(s) (Required) Date Sign Print Sign Print FOR DEPARTMENT USE ONLY Inspector Record Date Inspected:  Application Approved  Application Disapproved Inspector's Remarks: Inspector Date Commissioner, Planning & Natural Resources Date SIGN SIGN GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF PLANNING AND NATURAL RESOURCES DEVELOPMENT PERMIT APPLICATION FORM L&WD-3 ZONING REQUIREMENTS TABLE The following table shall be completed by the applicant with entries as appropriate for the zoning district in which the activity is taking place. Not all the requirements will necessarily apply to a particular zone. Consult the Zoning Law for guidance. Applicants Name: Signature: Date: Location of Activity (Plot No.): Estate: Zoning District: 1. Proposed use (residential etc.) 2. Accessory use if any 3. Number of onsite parking spaces: Existing Proposed 4. Area of lot: ft2 acres 5. Area covered by existing buildings ft2; Area covered by proposed buildings ft2 6. Total area of disturbance (includes footprint of all buildings, structures and parking areas) ft2 7. Setback of building from street property line: Required ft. Proposed ft. 8. Side yard setback: Required ft. Proposed ft. 9. Rear yard setback: Required ft. Proposed ft. 10. Height of building: ft. Stories 11. Lot width at street line (ft.) 12. Area of usable open space: ft. % of lot 13. Persons per acre ratio 14. Floor area ratio 15. Number of onsite parking and loading spaces 16. Building setback (yards 11, W-2 only) FOR DEPARTMENT USE ONLY Inspector: Date: Permit Application No. SIGN GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF PLANNING AND NATURAL RESOURCES DEVELOPMENT PERMIT APPLICATION FORM L&WD-4 MAJOR PROJECT SUMMARY DATA Section I. Applicant 1. Name, address and telephone number of applicant. 2. Name, address and telephone number of owner of Property and of developer. Section II. Summary of Proposed Development 3. Describe the proposed development Section III. Description of Proposed Development 4. Name of development 5. Plot No. 6. Zoning District: 7. PWD Map No. 8. Proposed use (residential, etc. as listed in Zoning Law): 9. Accessory use if any FORM L&WD-4 MAJOR PROJECT SUMMARY DATA Cont'd 10. Area of Lot(s) (acreage) 11. Area covered by existing buildings (sq. ft.) 12. Area covered by proposed buildings (sq. ft.) 13. Floor area total 14. Floor area ratio (B-1, B-2 zones only) 15. Number of buildings 16. Number of units total Person Persons 17. Schedule of units: Efficiencies x 1.5 Unit - 1 bedroom x 2 - 2 bedroom x 3 - 3 bedroom x 4 - Other x - Total Persons 18. Number of on-site parking and loading spaces 19. Maximum building height (stories/ft) 20. Adjoining property land use(s) 21. Setback of building from street property line (ft.) 22. Side yard setback (ft.) 23. Rear yard setback (ft.) 24. Density (person/acre) 25. Area of usable open space (sq. ft. % of lot) FORM L&WD-4 MAJOR PROJECT SUMMARY DATA Cont'd Section IV. Comments 26. Proposed Potable Water Supply (method & quality estimate gal/day) 27. Proposed Sewage Treatment (method & quality estimate gal/day) 28. Proposed Solid Waste Disposal (method & quality estimate lbs/day) 29. Proposed Electrical Supply (method & demand estimate KWH for single & 3 phase) 30. Air Conditioning (method & demand estimate (KWH) 31. Other Utilities 32. Other Section V. 33. Will the development extend onto or adjoin any beach tidelands, submerged lands or public trust lands? 34. Will the development maintain, enhance or conflict with public access to the shoreline and along the coast? 35. Will the development protect or provide moderate income housing opportunities? Will it displace moderate income housing? 36. How will the development affect traffic on the coastal access roads? Signature of owner or authorized agent Date SIGN GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF PLANNING AND NATURAL RESOURCES DEVELOPMENT PERMIT APPLICATION FORM L&WD-5 PROOF OF LEGAL INTEREST AFFIDAVIT I, being duly sworn depose and say that: Applicant(s)* (or John Doe of Entity Applicant) 1. am/is the (check one) (I or Entity/Applicant)  Record title owner (fee simple)  Lessee  Other (specify) Of the real property described as Parcel No(s) Estate Quarter Island *Applicant(s) is required to provide documentation for legal interest stated above (e.g. deed, lease, etc.) 2. I have the irrevocable approvals, permission, or power of attorney from all other persons with a legal interest in the property to undertake the work proposed in the permit application as more fully set forth in the exhibit (s) attached hereto: Signature Date Signature Date Print Print The foregoing instrument was acknowledged before me this day of 20 by at county (Name or Name/Title of Entity) of . Notary Public My Commission expires GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES -0- VIRGIN ISLANDS BUREAU OF INTERNAL REVENUE (DPNR FORM L&WD-6) APPLICATION FOR TAX FILING AND PAYMENT STATUS REPORT** Date: The applicant identified below hereby requests a letter certifying his or her tax filing and payment status for the purpose of receiving a Coastal Zone Management Permit from the Virgin Islands Department of Planning and Natural Resources pursuant to Act 5270, amending Sections 910 (a)(2) and 911 (d)(2) of the Coastal Zone Management Act (Title 12, Chapter 21, Virgin Islands Code). The applicant authorizes the Bureau of Internal Revenue to disclose any taxpayer information necessary to process this application to the Virgin Islands Department of Planning and Natural Resources, who may make such further disclosures as are necessary to carry out the requirements of the Coastal Zone Management Act, as amended. Name: Business Name: EIN/TIN: SSN: Please Indicate: Type of Business: *Corporation *Partnership Please check forms that you use:  Individual 1120, 1065, l 040, 941VI,  Other 722VI, 720B, 720VI, other (list) Date Business Started: Person Representing Applicant: Position: Signature: Mailing Address: Date: Telephone Number: Reply to: 6115 Estate Smith Bay, suite 225, St. Thomas VI 00802 – 340-715-1040(phone), 340-774-2672(fax) or 4008 Estate Diamond, St. Croix VI 00820 – 340-773-1040(phone), 340-773-1006(fax) * Partnership and/or Corporations must list partners/ corporate officers, social security numbers and addresses on a separate sheet and attach it to this application. THIS FORM IS TO BE SUBMITTED TO VIBIR UPON COMPLETION GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF PLANNING AND NATURAL RESOURCES DEVELOPMENT PERMIT APPLICATION FORM L&WD-7 CORPORATION/ASSOCIATION APPLICATION (To be used when a corporation or association is making a Permit Application in Tier l) (Corporation or Association Name) By: ___________________________ (Signature) Title/Position (Print) President or Vice-President or equivalent Print WITNESS: ATTEST: Secretary (or equivalent) Signature Secretary (or equivalent) Print Seal On this day of , 20 . before me the undersigned officer, personally appeared , who acknowledges himself to be the of ; that he executed the foregoing instrument in the capacity above and has the authority to execute this application on behalf of the company. IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day and year above written. ____________________________________________ Include Supporting Documents: 1. Compliance with Act No. 5270 by providing: (a) Tax clearance letter from the Bureau of Internal Revenue (b) Property tax clearance letter from the Lieutenant Governor’s Office. (c) Corporations and Associations: Certificate of Good Standing or equivalent, organizational documents & Amendments (Articles, Bylaws, Operating Agreement, Declarations) (d) Corporate Resolution (or equivalent) authorizing action on behalf of the company. (Form L&WD-8) 1:08:96 Flood Plain Determination and Permit Application To be completed by all applicants l. Owner: Mailing Address: Home Tel. #: Business Tel. #: Cellular #: 2. Designer: Lic. #: Tel. #: Cellular#: 3. Plot #: Estate: Quarter: Flood Zone Designation: If your flood zone designation is Zone A, AE, AO, Al-30, A99, V, VO, Ve or Vl-V30 as shown on the NFIP FIRM Map, then complete this section. *****************************NFIP Flood Zone Designation************************************* 1. Type of development: l or 2 Family dwelling ( ) Mobile Home ( ) Non-Structural ( ) 3 Family or more, Apartment or Condo Structure ( ) Non- Residential Structure: ( ) Commercial Structure ( ) New Construction ( ) Non-Structural ( ) Addition to Structure ( ) 50% Substantial Improvement of Existing Structure ( ) Description of Activity 2. Base F1ood Elevation at the Development Site is ft. above mean sea level (msl). 3. Elevation of the First F1oor, Basement or F1ood proof level for proposed structure is .ft. 4. Describe the Non Structural Activity i.e. septic tank, waste water treatment plants etc. (including the location and development: 5. Attach a certified copy of site plan (8.5” x 11) showing Base Flood Elevation. See sample attached. FOR OFFICE USE ONLY Is the property located in an identified Flood Hazard Area? ( ) YES ( ) NO NFIP Zone Designation: Forward to Flood Plain Manager: ( ) YES ( ) NO Application: APPROVED ( ) DENIED ( ) RESUBMIT ( ) Plan Reviewer Name: Signature: Date: ENG FORM 4345 CHECKLIST Additional information may be requested depending on site location and site conditions.  Provide the name, mailing address, and contact information of the applicant, agent, and/or consultant (Blocks 5 through 10).  Applicant’s signature if agent or consultant is employed. (Block 11)  Please provide name identifying the proposed project, e.g., Landmark Plaza. (Block 12)  Provide the project’s location including but not limited to name of waterbody, municipality, section, township, range, address of work, State Tax Parcel ID, latitude and longitude, and driving directions.(Blocks 13 through 17)  Describe the overall activity. Indicate whether discharge of dredged material or fill material is involved. (Block 18) o For Docks and Piers please provide the following:  Construction methodology (i.e. wood, concrete, floating, etc.)  Type of vessel and proposed use (recreational use by applicant, rental, commercial use by applicant, etc.)  Number of existing slips (show the location of each slip on the project drawings as well) o For excavation/dredging activity(ies) provide the following:  Description, dimension, and location to be excavated/dredged (open water, existing channel, etc.)  Method of excavation/dredging (hydraulic, clamshell, barge-mounted crane, etc.)  Description, dimensions, and location of disposal site o For Shoreline Stabilization please provide the following:  Type of fill material to be used (i.e. concrete, wood, rock, etc.)  Construction methodology (type of equipment, from land or by barge, etc.)  Volume of backfill, if applicable  State the purpose and need for the project; describe the intended use of the proposed activity. (Block 19)  For Fill and Excavation Activities provide the following (Blocks 20 through 22): o Describe the area to be filled; i.e. wetlands or open water and give dimension in square feet or acres o Describe the quantity of fill material to be used in cubic yards o Describe the type and composition of the fill material and its source (i.e. rock, sand, clay, concrete, etc.) o Describe any temporary construction and access fills that may be required  Provide a statement to show how the proposed impacts to waters of the U.S. (i.e. wetlands, surface waters, etc.) have been avoided, minimized, and compensated; or a brief description of why you believe mitigation is not required (Block 23)  If work has begun or has been completed please provide a brief description of the completed activities.(Block 24)  Provide the names and mailing addresses of the Adjoining Property Owners, Lessees, etc. whose property adjoins the project site or who may be affected by the proposed activity. (Block 25)  Indicate if you have applied for or received authorization from other federal, state, or local agencies for the project. (Block 26)  Provide the signature of the applicant or authorized party. (Block 27) Drawing and Illustration Information:  Provide location map indicating site location and boundaries.  Provide overlay of site conditions (i.e. wetlands and/or surface waters) with the proposed activity  Provide separate plan view and cross-sectional drawings for existing and proposed site conditions.  Provide black and white legible plan view drawings on 8 ½” X 11” sized paper to include: o North arrow o Dimensions of existing and proposed activity(ies) o Total plan of development o Indicate the location of cross-sectional views o Dimensions of site conditions to include the location of waters of the U.S.  Provide black and white legible cross-sectional drawings on 8 ½” X 11” sized paper to include: o Dimensions of proposed work o Indicate the mean/ordinary high water line and mean/ordinary low water line for project adjacent to waters of the U.S. Supplemental Drawing Information:  For In-Water Activities: o Indicate the height above the mean high water line, especially for docks or other in-water structures o Indicate the length of shoreline o Indicate the location of any vegetation along the shoreline and in-water resources (i.e. seagrasses, oysters, coral) o Volume of dredge material noted on the drawing if applicable o Existing and proposed water depths if dredging is proposed o Distance to any Federal Channel and width of waterway  For Fill or Excavation Activities: o Label area to be filled and/or excavated in acres or square feet o Distances of proposed activities to avoided resources. Instructions for Preparing a Department of the Army Permit Application Blocks 1 through 4. To be completed by Corps of Engineers. Block 5. Applicant’s Name. Enter the name and the E-mail address of the responsible party or parties. If the responsible party is an agency, company, corporation, or other organization, indicate the name of the organization and responsible officer and title. If more than one party is associated with the application, please attach a sheet with the necessary information marked Block 5. Block 6. Address of Applicant. Please provide the full address of the party or parties responsible for the application. If more space is needed, attach an extra sheet of paper marked Block 6. Block 7. Applicant Telephone Number(s). Please provide the number where you can usually be reached during normal business hours. Blocks 8 through 11. To be completed, if you choose to have an agent. Block 8. Authorized Agent’s Name and Title. Indicate name of individual or agency, designated by you, to represent you in this process. An agent can be an attorney, builder, contractor, engineer, or any other person or organization. Note: An agent is not required. Blocks 9 and 10. Agent’s Address and Telephone Number. Please provide the complete mailing address of the agent, along with the telephone number where he / she can be reached during normal business hours. Block 11. Statement of Authorization. To be completed by applicant, if an agent is to be employed. Block 12. Proposed Project Name or Title. Please provide name identifying the proposed project, e.g., Landmark Plaza, Burned Hills Subdivision, or Edsall Commercial Center. Block 13. Name of Waterbody. Please provide the name of any stream, lake, marsh, or other waterway to be directly impacted by the activity. If it is a minor (no name) stream, identify the waterbody the minor stream enters. Block 14. Proposed Project Street Address. If the proposed project is located at a site having a street address (not a box number), please enter it here. Block 15. Location of Proposed Project. Enter the latitude and longitude of where the proposed project is located. If more space is required, please attach a sheet with the necessary information marked Block 15. Block 16. Other Location Descriptions. If available, provide the Tax Parcel Identification number of the site, Section, Township, and Range of the site (if known), and / or local Municipality that the site is located in. Block 17. Directions to the Site. Provide directions to the site from a known location or landmark. Include highway and street numbers as well as names. Also provide distances from known locations and any other information that would assist in locating the site. You may also provide description of the proposed project location, such as lot numbers, tract numbers, or you may choose to locate the proposed project site from a known point (such as the right descending bank of Smith Creek, one mile downstream from the Highway 14 bridge). If a large river or stream, include the river mile of the proposed project site if known Block 18. Nature of Activity. Describe the overall activity or project. Give appropriate dimensions of structures such as wing walls, dikes (identify the materials to be used in construction, as well as the methods by which the work is to be done), or excavations (length, width, and height). Indicate whether discharge of dredged or fill material is involved. Also, identify any structure to be constructed on a fill, piles, or float-supported platforms. The written descriptions and illustrations are an important part of the application. Please describe, in detail, what you wish to do. If more space is needed, attach an extra sheet of paper marked Block 18. Block 19. Proposed Project Purpose. Describe the purpose and need for the proposed project. What will it be used for and why? Also include a brief description of any related activities to be developed as the result of the proposed project. Give the approximate dates you plan to both begin and complete all work. Block 20. Reasons for Discharge. If the activity involves the discharge of dredged and/or fill material into a wetland or other waterbody, including the temporary placement of material, explain the specific purpose of the placement of the material (such as erosion control). Block 21. Types of Material Being Discharged and the Amount of Each Type in Cubic Yards. Describe the material to be discharged and amount of each material to be discharged within Corps jurisdiction. Please be sure this description will agree with your illustrations. Discharge material includes: rock, sand, clay, concrete, etc. Block 22. Surface Areas of Wetlands or Other Waters Filled. Describe the area to be filled at each location. Specifically identify the surface areas, or part thereof, to be filled. Also include the means by which the discharge is to be done (backhoe, dragline, etc.). If dredged material is to be discharged on an upland site, identify the site and the steps to be taken (if necessary) to prevent runoff from the dredged material back into a waterbody. If more space is needed, attach an extra sheet of paper marked Block 22. Block 23. Description of Avoidance, Minimization, and Compensation. Provide a brief explanation describing how impacts to waters of the United States are being avoided and minimized on the project site. Also provide a brief description of how impacts to waters of the United States will be compensated for, or a brief statement explaining why compensatory mitigation should not be required for those impacts. Block 24. Is Any Portion of the Work Already Complete? Provide any background on any part of the proposed project already completed. Describe the area already developed, structures completed, any dredged or fill material already discharged, the type of material, volume in cubic yards, acres filled, if a wetland or other waterbody (in acres or square feet). If the work was done under an existing Corps permit, identity the authorization, if possible. Block 25. Names and Addresses of Adjoining Property Owners, Lessees, etc., Whose Property Adjoins the Project Site. List complete names and full mailing addresses of the adjacent property owners (public and private) lessees, etc., whose property adjoins the waterbody or aquatic site where the work is being proposed so that they may be notified of the proposed activity (usually by public notice). If more space is needed, attach an extra sheet of paper marked Block 24. Information regarding adjacent landowners is usually available through the office of the tax assessor in the county or counties where the project is to be developed. Block 26. Information about Approvals or Denials by Other Agencies. You may need the approval of other federal, state, or local agencies for your project. Identify any applications you have submitted and the status, if any (approved or denied) of each application. You need not have obtained all other permits before applying for a Corps permit. Block 27. Signature of Applicant or Agent. The application must be signed by the owner or other authorized party (agent). This signature shall be an affirmation that the party applying for the permit possesses the requisite property rights to undertake the activity applied for (including compliance with special conditions, mitigation, etc.). DRAWINGS AND ILLUSTRATIONS General Information. Three types of illustrations are needed to properly depict the work to be undertaken. These illustrations or drawings are identified as a Vicinity Map, a Plan View or a Typical Cross-Section Map. Identify each illustration with a figure or attachment number. Please submit one original, or good quality copy, of all drawings on 8½ x11 inch plain white paper (electronic media may be substituted). Use the fewest number of sheets necessary for your drawings or illustrations. Each illustration should identify the project, the applicant, and the type of illustration (vicinity map, plan view, or cross- section). While illustrations need not be professional (many small, private project illustrations are prepared by hand), they should be clear, accurate, and contain all necessary information. SIGN SIGN SIGN