ࡱ> '` !bjbjDD 7&&:\\\\pApApA8ATBfLCC"DDDLELELEnpppppp$khӔLEHELELELE\\DD4 IIILE\8DDnILEnIIjʆD@C ?+pAE2:4ɏ<NuhFudu4ILELELE6IjLELELELELELELEdD0d0\\\\\\  Riparian Repair & Maintenance California Wetlands Form and Habitat Map (Short Form) for Stream Repair and Maintenance Projects with no permanent habitat loss in the San Francisco Bay Region of the California Water BoardTwo brackets [ ] represent a checkbox; check a checkbox like this: [x]. For text responses, add text after the colon, on the next line if necessary. Provide all dates as mm/dd/yyyy. See the companion Form Instructions for more information. Note: A map shall be submitted with this form; see instructions below under "Habitat Map".  SEQ FieldItem \* Arabic \* MERGEFORMAT 1. Form completed by [ ] Applicant [ ] Other (specify) Name Phone/email  SEQ FieldItem \* Arabic \* MERGEFORMAT 2. Date of submission: PROJECT IDENTIFICATION Complete all applicable bolded fields. Non-bolded fields are optional. See instructions for a key to abbreviations. SEQ FieldItem \* Arabic \* MERGEFORMAT 3. Corps File No:  SEQ FieldItem \* Arabic \* MERGEFORMAT 4. Date of permit:  SEQ FieldItem \* Arabic \* MERGEFORMAT 5. Water Board CIWQS Place No:  SEQ FieldItem \* Arabic \* MERGEFORMAT 6. Certification Letter/Notice of Applicability Site No. AND/OR Board Order No. (WDR): Staff Initials:  SEQ FieldItem \* Arabic \* MERGEFORMAT 7. Date of letter/order: APPLICANT INFORMATION 8. Applicant name and/or organization: 9. Mailing Address: 10. Email:11. Phone: CONTACT FOR TECHNICAL INFORMATION (if different from applicant)12. Contact Name: 13. Organization Name: 14. Mailing Address: 15. Email: 16. Phone: GENERAL INFORMATION 17. Project name (include any alternative names): 18. County19: Location Latitude: Longitude: Datum (if known): Decimal degrees of approximate center of site, NAD83 datum preferred 20. Brief project description 21. Project size Indicate extent of riparian area to be impacted and enhanced in both acres and linear feet Impacted acres __________________; linear feet ____________________ Enhanced acres __________________; linear feet ____________________ 22. Project type (see definitions to right) Check all that apply: [ ] Stream Bank Stabilization [ ] Sediment/Debris Removal [ ] Vegetation Management [ ] Drainage Improvement Definitions for project type Stream Bank Stabilization: primary purpose is to prevent excessive erosion of stream bank, restore proper channel function, and enhance habitat Sediment/Debris Removal: primary purpose is to remove sediment and debris from stream channel to maintain flood conveyance capacity Vegetation Management primary purpose is to remove vegetation from stream channel to maintain flood conveyance capacity and enhance habitat Drainage Improvement: primary purpose is to replace structures such as culverts, outfalls, outlets, or other drainage devices in the stream channel to maintain flood conveyance capacity and enhance habitat 23. Estimated dates for groundwork and monitoring [If construction [or groundwork] is delayed by more than 3 months, the applicant shall notify the Water Board via  HYPERLINK "mailto:habitatdata@waterboards.ca.gov" habitatdata@waterboards.ca.gov within 30 days.] Estimated groundwork start date: Estimated groundwork end date: Estimated monitoring start date: Estimated monitoring end date: PERFORMANCE CRITERIA24. Performance Criteria and Measurement: Indicate the criteria and methods used to evaluate the success of the project. Criteria can be extracted from the permit; attach a separate file if necessary. See instructions for examples of performance criteria. 25. Native Vegetation Planting List Paste from application or permit into this area a list of the number of each plant species that will be planted as part of this project. If no planting will occur, list species by habitat type expected to develop. Note that target vegetation should be native species. 26. Other project conditions in permit (Add as necessary)  REPORTING27. Reporting requirements Check all that apply [ ]Monitoring reports are required every: [ ] year [ ] 2 years [ ] years, over a total required monitoring period of years. [ ] other schedule: [ ]Photographs are required: [ ] pre-project construction (existing conditions) [ ] post-project construction (as-built) every: [ ] year [ ] 2 years [ ] years, over a total required monitoring period of years. [ ] other schedule: [ ] Not applicable  HABITAT MAPS 28. Submit with this form a single map indicating: the boundaries of the project area Examples of habitat maps can be found at www.californiawetlands.net/tracker/map-examples Indicate the map format used (listed in order of preference): [ ] (Recommended) Google KML files saved from Google Maps: My Maps (free) or Google Earth Pro (not free). Maps must show the boundaries of all project habitats, using the habitat list provided on this form. See  HYPERLINK "http://www.californiawetlands.net/tracker/map-examples" http://www.californiawetlands.net/tracker/map-examples [ ] GIS shapefiles. The shapefiles must depict the boundaries of all project habitats, using the habitat list provided on this form. Each shape should be attributed with the habitat name. Features and boundaries should be accurate to within 33 feet (10 meters). If possible, provide map in NAD83/WGS84 datum, UTM Zone 10 projection; identify datum/projection used. [ ] Other electronic format (CAD or illustration format) that provides a context for location (inclusion of landmarks, known structures, geographic coordinates, or USGS DRG or DOQQ). Maps must show the boundaries of all habitats, using the habitat list provided on this form. [ ] Habitats maps marked on paper USGS 7.5 minute topographic maps or DOQQ printouts. Maps must show the boundaries of all habitats, using the habitat list provided on this form.29. 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