ࡱ> !` ~bjbj\\ >>v4H&&&&p'|H@(....w/23???????$;AhCz?W4w/w/W4W4?..?@444W4..?4W4?446D7.( @!8&m4"7h7$U@0@7,D4(DD7DD7$W4W44W4W4W4W4W4??4W4W4W4@W4W4W4W4HHH!&HHH&HHH JOINT APPLICATION FORM1. Application Number (to be assigned by Agency)2. Date3. For agency use only (Date Received) FORMTEXT      Month Day Year4. Name and address of applicant5. Name, address, and title of authorized agent FORMTEXT       FORMTEXT      Telephone no. during business hours include area code( FORMTEXT    ) FORMTEXT      Telephone no. during business hours include area code( FORMTEXT    ) FORMTEXT      ( FORMTEXT    ) FORMTEXT      ( FORMTEXT    ) FORMTEXT      6. Project Description and Remarks: Describe in detail the proposed activity, its purpose, and intended use. Also indicate the drainage area at the watershed to the downstream limit. Use attachments if needed. FORMTEXT      7. Names, addresses, and telephone numbers of all adjoining and potentially affected property owners, including the owner of the subject property if different from applicant. FORMTEXT      8. Location of activityLegal Description: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      1/4SecTwp.RgeP.M.Name of waterway at location of the activityUTM (Universal Transverse Mercator): If available FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Address:ZoneNorthEastStreet, road, or other descriptive location FORMTEXT       FORMTEXT      In or near city or townName of Local Governing Community FORMTEXT       FORMTEXT       FORMTEXT      CountyStateZip Code9. Date activity is proposed to commence FORMTEXT      Estimated Time of Construction FORMTEXT      10. Is any portion of the activity for which authorization is sought now complete?Yes FORMTEXT    No FORMTEXT    If answer is  Yes give reasons in item 6.Month and Year the activity was completed FORMTEXT      Indicate the existing work on drawings.11. List all approvals or certifications required by other federal, interstate, state, or local agencies for any structures, construction, discharges, deposits, or other activities described in this application. If this form is being used for concurrent application to the Corps of Engineers, Illinois Department of Natural Resources, and Illinois Environmental Protection Agency, these agencies need not be listed.Issuing AgencyType of ApprovalIdentification No.Date of ApplicationDate of Approval FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT   .0    " $ & * < L N      4 ̹أveQvv&jhTCJOJQJUmHnHu!jhTCJOJQJUhTCJOJQJjhTCJOJQJUhT>*CJOJQJhACJOJQJ*jhTCJEHOJQJUmHnHu%jhTCJEHOJQJUhTCJEHOJQJjhTCJEHOJQJUhTCJOJQJhTOJQJ hTEH.0$If^kd$$IfsC++0+4 sal$If~" $ uofo $$Ifa$$Ifkd$$Ifs4F +  0+    4 salf4$ & ( * H J L uofffo $$Ifa$$Ifkd=$$Ifs4wF +`  `0+    4 salf4L N RLL$Ifkdw$$Ifs4Cr %+  0  0+4 salf4  F $Ifqkd$$Ifs0+0+4 sal4 6 8 B D F H    t x z º k Xk %j(hTCJEHOJQJU*jhTCJEHOJQJUmHnHu%jhTCJEHOJQJUhTCJEHOJQJjhTCJEHOJQJUhTCJOJQJhTOJQJhTCJOJQJ&jhTCJOJQJUmHnHujhTCJOJQJU!j[hTCJOJQJUF H r  2 P t x  $$Ifa$$Ifqkd$$Ifs0+0+4 sal      " & ( < ܺܺܺܺxܺܺeܺܺ%jhTCJEHOJQJU%jJhTCJEHOJQJUhTCJOJQJhTOJQJ%j hTCJEHOJQJUhTCJOJQJhTCJEHOJQJ*jhTCJEHOJQJUmHnHujhTCJEHOJQJU%jhTCJEHOJQJU# " & J N v x $&^kd$$Ifs,++0+4 salFf $$Ifa$Ff3 $If< > @ F H J N P d f h r t v x $&(<>@JLNPܺܺܺ}l}X}}&jhTCJOJQJUmHnHu!jhTCJOJQJUjhTCJOJQJUhTCJOJQJhTOJQJ%jhTCJEHOJQJUhTCJOJQJhTCJEHOJQJ*jhTCJEHOJQJUmHnHujhTCJEHOJQJU%j4hTCJEHOJQJU&NP=^kd$$Ifso++0+4 sal^kd$$Ifsg++0+4 sal$If46JLNXZ\^rtvºkXkEk%jhTCJEHOJQJU%j"hTCJEHOJQJU*jhTCJEHOJQJUmHnHu%jhTCJEHOJQJUhTCJEHOJQJjhTCJEHOJQJUhTCJOJQJhTOJQJhTCJOJQJ&jhTCJOJQJUmHnHujhTCJOJQJU!jhTCJOJQJU4\ $$Ifa$$If^kd$$Ifs++0+4 sal &(*8:np02FHJTVXZn㝕㝕o%j$hTCJEHOJQJU%jhTCJEHOJQJUhTOJQJhTCJOJQJ%jhTCJEHOJQJU*jhTCJEHOJQJUmHnHu%jhTCJEHOJQJUhTCJEHOJQJjhTCJEHOJQJU($Ifkd$$Ifs4ִ #&*+``````*`}0+    4 salf4*,.02468:<>@HPZblnpr0XFf"Ff $$Ifa$$Ifnpr|~vxܺܺܺܺܺrfSr%j,+hTCJEHOJQJUhTCJEHOJQJjhTCJEHOJQJU%j'hTCJEHOJQJUhTOJQJhTCJOJQJ%jq%hTCJEHOJQJUhTCJEHOJQJ*jhTCJEHOJQJUmHnHujhTCJEHOJQJU%j$hTCJEHOJQJU&kd%$$Ifs4֞o: #&*+`{`E `F`F`N`}0+4 salf4$If$If,&&&$Ifkd'$$Ifs4֞o: #&*+ {` E F F N }0+4 salf4$If $$Ifa$v,&&&$Ifkd)$$Ifs4֞o: #&*+{  E FFN }0+4 salf4LNPRfhjtvxzļĬwļļĬdwQw%j0hTCJEHOJQJU%j>0hTCJEHOJQJU*jhTCJEHOJQJUmHnHu%j-hTCJEHOJQJUhTCJEHOJQJjhTCJEHOJQJUhTOJQJhTCJOJQJhTCJEHOJQJjhTCJEHOJQJU*jhTCJEHOJQJUmHnHu_kd+$$Ifs4n\o*+`{``}0+4 salf4$IfJLe_____$Ifkdv-$$Ifs4)\o*+ {  }0+4 salf4LNPxRLLLLL$Ifkd.$$Ifs4Cro*+ {3}0+4 salf4RThjlvxzwd%j_6hTCJEHOJQJU%j~4hTCJEHOJQJU%j4hTCJEHOJQJUhTCJEHOJQJhTCJOJQJhTOJQJ*jhTCJEHOJQJUmHnHu%j*1hTCJEHOJQJUjhTCJEHOJQJUhTCJEHOJQJ'RLLLLL$Ifkd1$$Ifs4)roq$*+ {t}0+4 salf4RzRLLLL$Ifkd2$$Ifs4~ro$*+ {s}0+4 salf46e______$Ifkd4$$Ifs43\ !+    0+4 salf468"$&(<㮦㮦zg%j<hTCJEHOJQJUhT>*CJOJQJhThTCJOJQJ%j8hTCJEHOJQJUhTOJQJhTCJEHOJQJ*jhTCJEHOJQJUmHnHu%j6hTCJEHOJQJUhTCJEHOJQJjhTCJEHOJQJU"68?999$Ifkdc7$$Ifs4]ֈXn: +yW 0+4 salf4xr$Ifkdb9$$Ifs4MF : + bW 0+    4 salf4 $$Ifa$$Ifakd:$$Ifs4++0+4 salf4&NvOIIIII$Ifkd8;$$Ifs4r $+ Y0+4 salf4<>@JLNPdfhrtvxܺܺܺܺܺܺܺyܺfܺܺ%j"@hTCJEHOJQJUhTOJQJ%j^>hTCJEHOJQJU%j=hTCJEHOJQJU%jr=hTCJEHOJQJUhTCJEHOJQJ*jhTCJEHOJQJUmHnHujhTCJEHOJQJU%j<hTCJEHOJQJU$@hOIIIII$Ifkd>$$Ifs4*r $+ Y0+4 salf4 .02<>@BVXZdfhj~ܺܺܺܺܺܺܺyܺfܺܺ%jChTCJEHOJQJUhTOJQJ%jAhTCJEHOJQJU%jlAhTCJEHOJQJU%j@hTCJEHOJQJUhTCJEHOJQJ*jhTCJEHOJQJUmHnHujhTCJEHOJQJU%j@hTCJEHOJQJU$ p2pZpOIIIII$IfkdXB$$Ifs4+r $+ Y0+4 salf4ppp p p p"p$p.p0p2p4pHpJpLpVpXpZp\p^prptpvppppppܺܺƥܺܺܺܺܺwܺdܺܺ%j*GhTCJEHOJQJUhTOJQJ%jfEhTCJEHOJQJU%jDhTCJEHOJQJUU%jzDhTCJEHOJQJUhTCJEHOJQJ*jhTCJEHOJQJUmHnHujhTCJEHOJQJU%jDhTCJEHOJQJU&    FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      12. Has any agency denied approval for the activity described herein or for any activity directly related to the activity described herein?Yes FORMTEXT    No FORMTEXT    (If  Yes , explain in item 6.)13. Application is hereby made for authorizations of the activities described herein. I certify that I am familiar with information contained in the application, and that to the best of my knowledge and belief, such information is true, complete, and accurate. I further certify that I possess the authority to undertake the proposed activities.Signature of Applicant or Authorized Agent FORMTEXT      Typed or Printed Name of Applicant or Authorized AgentNCR FORM 426 08 AUG 02  FORMCHECKBOX  CORPS OF ENGINEERS COPY  FORMCHECKBOX  IDNR/OWR COPY  FORMCHECKBOX  IEPA COPY  FORMCHECKBOX  APPLICANT S COPY PROJECT DESCRIPTION  FORMTEXT       LOCATION:  FORMTEXT       NCR FORM 426 SHEET  FORMTEXT     OF  FORMTEXT     08 AUG 02  FORMCHECKBOX  CORPS OF ENGINEERS COPY  FORMCHECKBOX  IDNR/OWR COPY  FORMCHECKBOX  IEPA COPY  FORMCHECKBOX  APPLICANT S COPY VICINITY MAP LIST OF ADJACENT PROPERTY OWNERSPROJECT DESCRIPTIONNO.NAMEADDRESS FORMTEXT      1. FORMTEXT       FORMTEXT      2. FORMTEXT       FORMTEXT      LOCATION:3. FORMTEXT       FORMTEXT       FORMTEXT      4. 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