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Appendix D BCDC Application Form December 28, 2020

14 CA ADC Div. 5 App. DBarclays Official California Code of Regulations

Barclays California Code of Regulations
Title 14. Natural Resources
Division 5. San Francisco Bay Conservation and Development Commission
Appendices
14 CCR Div. 5 App. D
Appendix D BCDC Application Form December 28, 2020
Currentness
Box 1 Property Ownership and Applicant Information
(must be completed by all applicants)
a. APPLICANT:
Empty Checkbox​ Owns project site Empty Checkbox​ Leases project site Empty Checkbox​ Homeowner Association owns/will own Empty Checkbox​ Other Property Rights: __________
APPLICANT'S REPRESENTATIVE: Empty Checkbox​ None
Name/Title: __________ Name/Title: __________
Address: __________ Address: __________
City, State, Zip: __________ City, State, Zip: __________
Telephone: ___/__________ Fax: ___/__________ Telephone: ___/__________ Fax: ___/__________
Email: __________ Email: __________
I hereby authorize__________to act as my representative and bind me in all matters concerning this application.
 
 
 
Signature of Applicant
Print Name
Date
b. CO-APPLICANT:
Empty Checkbox​ Owns project site Empty Checkbox​ Leases project site Empty Checkbox​ Homeowner Association owns/will own Empty Checkbox​ Other Property Rights: __________
CO-APPLICANT'S REPRESENTATIVE: Empty Checkbox​ None
Name/Title: __________Name/Title: __________
Address: __________ Address: __________
City, State, Zip: __________ City, State, Zip: __________
Telephone: ___/__________ Fax: ___/__________ Telephone: ___/__________ Fax: ___/__________
Email: __________ Email: __________
I hereby authorize__________to act as my representative and bind me in all matters concerning this application.
 
 
 
Signature of Co-Applicant
Print Name
Date
c. PROPERTY OWNER: Empty Checkbox​ Same As Applicant or Co-Applicant OWNER'S REPRESENTATIVE: Empty Checkbox​ None
Name/Title:
 
Name/Title:
 
Address:
 
Address:
 
City, State, Zip:
 
City, State, Zip:
 
Telephone:
___
/
_______
Fax:
___
/
 
Telephone:
___
/
_______
Fax:
___
/
 
Email:
 
Email:
 
I hereby authorize__________to act as my representative and bind me in all matters concerning this application.
 
 
 
Signature of Owner
Print Name
Date
d. Provide documentation of property interests, such as a copy of a grant deed, lease or easement, and Conditions Covenants and Restrictions, for a homeowner's association, that demonstrates that the owner or applicant has adequate legal interest in the property to undertake the proposed project. See Commission regulations Appendix F for complete details.
e. DISCLOSURE OF CAMPAIGN CONTRIBUTIONS:
The following contributions of more than $250 were made by the applicant or applicant's representative to a BCDC commissioner or commissioner's alternate in the preceding twelve months to support the commissioner's or alternate's campaign for election to a local, state or federal office.
Contribution Made To
Contribution Made By:
Date of Contribution:
 
 
 
 
 
 
Empty Checkbox​ No such contributions have been made.
f. CERTIFICATION OF ACCURACY OF INFORMATION AND AUTHORIZATION TO INSPECT:
I hereby certify under penalty of perjury that to the best of my knowledge the information in this application and all attached exhibits is full, complete, and correct, and I understand that any misstatement or omission of the requested information or of any information subsequently requested shall be grounds for denying the permit, for suspending or revoking a permit issued on the basis of these or subsequent representations, or for the seeking of such other and further relief as may seem proper to the Commission. I further agree that the Commission staff may, with 24 hours notice, inspect the project site while this application is pending.
Empty Checkbox​
 
 
Signature of Applicant or Applicant's Representative
Date
Empty Checkbox​
 
 
Signature of Co-applicant or Co-applicant's Representative
Date
Empty Checkbox​
 
 
Signature of Co-applicant or Co-applicant's Representative
Date
Empty Checkbox​
 
 
Signature of Co-applicant or Co-applicant's Representative
Date
Box 2 Total Project and Site Information
(must be completed by all applicants)
a. Project Street Address:__________
b. City, County, Zip:__________
c. Assessor's Parcel Number(s):____________________
d. Latitude: __________Longitude:__________
e. Previous BCDC permit number(s) for work at this site:__________
f. Project Name: __________
g. Brief Project Description: ____________________
h. Date work is expected to begin: __________
Date work is expected to be completed: __________
i. Total Project Cost: $__________
j. Length of shoreline on the project site:__________ feet
k. Length of shoreline at adjacent property owned or controlled by the applicant: __________feet
l. Approximate size of project site within BCDC's “shoreline band” jurisdiction: __________ square feet
m. Approximate size of project site within BCDC's “Bay” or “certain waterway” jurisdiction: __________ square feet
n. Approximate size of project site within BCDC's managed wetland or salt pond jurisdiction: __________ square feet
o. Approximate size of project site within the Suisun Marsh: __________ square feet
p. Approximate size of project site outside of BCDC's jurisdiction __________ square feet
q. Approximate total size of project site (including areas outside BCDC's jurisdiction): __________ square feet
r. Area of total project site reserved for non-public access uses: __________ square feet
s. Area of total project site reserved for public access: __________ square feet
t. Does the project involve development within the primary management area of the Suisun Marsh?
Empty Checkbox​Yes
Empty Checkbox​No
If “Yes,” provide any relevant duck club number(s): __________
u. Project Details. Complete all that apply.
Proposed Elements of the Project
In BCDC's Bay, Certain Waterway, Managed Wetlands or Suisun Marsh Jurisdiction*
In BCDC's Shoreline Band jurisdiction
Outside BCDC's jurisdiction
Totals
1.
Structures
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
2.
All Roads, Parking, Pathways, Sidewalks
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
3.
Number of Parking Spaces:
4.
All Landscaping
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
5.
Left undeveloped
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
6.
Shoreline Protection
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
7.
Piers, docks and other marine-related purposes
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
8.
Areas used for other purposes (specify)
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
Totals:
______sq.ft.
______sq.ft.
______sq.ft.
______sq.ft.
* If project will occur in more than one of these jurisdictions, provide the requested information for each area separately.
v. INFORMATION ABOUT THE TOTAL PROJECT AND SITE (PROVIDE IN AN ATTACHMENT):
1. Provide a detailed project description.
2. Describe the existing condition of the site, including the elevations, underwater topography, vegetation, structures and uses. Provide one or more photographs of existing site conditions.
3. Identify bathymetric features, tidal hydrology and sediment movement at the project site and describe how the project may influence these factors.
4. Endangered or Threatened Species.
a. identify any known threatened or endangered species, or any species that the California Department of Fish and Wildlife or a federal wildlife agency has determined are candidates for listing as threatened or endangered species, or any species that provide substantial public benefits that may be found at the project site.
b. Provide any “take” authorizations issued by the state or federal resource agencies.
c. Provide any “biological opinion” issued by a state or federal agency as the result of an endangered species consultation.
5. Identify any subtidal areas that are scarce or that have an abundance and diversity of fish, other aquatic organisms and wildlife (e.g., eel grass beds, sandy deep water or underwater pinnacles) at the site. Add the identified areas to the project site plan (see below).
6. Indicate whether the project would involve the release of pollutants or have the potential for accidental pollutant discharge into the Bay. If so, describe how the proposed project has been designed and would be constructed and maintained to prevent or minimize the discharge of pollutants into the Bay, including non-point source pollution (storm water runoff). Provide any storm water pollution prevention plans, when available, storm water management plans, or other water pollution or erosion and sediment control plans showing proposed best management practices developed for the project and the project site.
7. Identify any suspected or known sites of toxic contamination on or in proximity to the project site, and provide the following information: (a) the types of pollutants present; (b) the location of the pollutants (show on the site plan); (c) the extent to which the pollutants are accessible to humans, fish, wildlife or vegetation, or are moving offsite; and (d) steps being taken (including government actions) to control or clean up the pollutants.
8. Provide a copy of any water quality certification or waste discharge requirements that are required by the San Francisco Bay Regional Water Quality Control Board, and any approvals that are required by the State Department of Toxic Substances Control.
9. You must provide information to show that your project would be consistent with the Commission's laws and policies. This application addresses the most common policies raised by most projects. The Commission staff will assist you in identifying additional policies, if any, that apply to your project. Once they are identified, please explain how they offer support for your project and how the project would be consistent with them. The Commission's laws and policies may be found in the digital library at www.bcdc.ca.gov.
10. PROJECT PLANS: Provide the following types of plans: (a) vicinity map sized 8.5″x11″; (b) public access and open space exhibit; (c) project site plan reduced to 8.5″x11″; and (d) full-sized project site plan.
PLAN REQUIREMENTS: The public access and open space exhibit must include property boundaries, proposed structures, and an accurate depiction of areas to be provided as public access, open space and view corridors. At a minimum, the project site plan must include property boundaries, all existing and proposed structures and improvements (with cross sections and elevations if necessary), and any tidal marshes and tidal flats. All plans must include a graphic scale, a north arrow, the date and name of the person who prepared the plans, and a depiction of the edge of the Commission's jurisdiction over the Bay or certain waterway (mean high water or, in tidal marshlands, the inland edge of marsh vegetation up to five feet above Mean Sea Level), and the edge of the Commission's shoreline band jurisdiction (100 feet wide measured from the edge of the Bay). See also Appendix F for details.
Box 3 Fill Information
(“Fill” means earth or any other substance or material, including pilings or structures placed on pilings, and structures floating at some or all times and moored for extended periods, such as houseboats and floating docks. Gov. Code Section 66632(a))
a. Complete this box if fill would be placed in any of these areas (check all those that apply):
Empty Checkbox​ San Francisco Bay Empty Checkbox​ Salt pond Empty Checkbox​ Managed wetland
Empty Checkbox​ “Certain waterway” Empty Checkbox​ Primary management area of the Suisun Marsh Empty Checkbox​ Other: __________
b. Surface area of tidal and subtidal property to be covered with fill: __________ square feet
c. Total volume of solid fill to be placed in tidal and subtidal areas: __________ cubic yard
d. Type of Fill. Surface area of proposed:
Solid fill: __________ square feet
Floating fill: __________ square feet
Pile-supported fill: __________ square feet
Cantilevered fill: __________ square feet
Total area to be filled: __________ square feet
e. Types of Areas to be Filled. Of the total area to be filled, what is the footprint of fill that would be placed in:
Open water: __________ square feet
Tidal marsh: __________ square feet
Tidal flat: __________ square feet
Salt pond: __________ square feet
Managed wetlands in the primary management area of the Suisun Marsh: __________ square feet
Other managed wetlands: __________ square feet
f. Area on new fill to be reserved for:
Private, commercial, or other non-public-access uses: __________ square feet
Public access: __________ square feet
g. INFORMATION REGARDING FILL (PROVIDE IN AN ATTACHMENT):
1. Provide dimensions of portions of all structures to be built on new fill, including length, width, area, height and number of stories.
2. Provide one or more photographs of existing shoreline conditions.
3. Explain the purpose of fill in the Bay, salt pond, managed wetland, certain waterway, or Suisun Marsh considering that the Commission can approve new fill for only five purposes: (a) accommodating a water-oriented use; (b) minor fill for improving shoreline appearance; (c) minor fill for providing new public access to the Bay; (d) accommodating a project that is necessary to the health, safety, or welfare of the public in the entire Bay Area; and (e) accommodating a project in the Suisun Marsh that is consistent with either: (1) the Suisun Marsh Preservation Act and the Suisun Marsh Protection Plan; or (2) the Suisun Marsh Local Protection Program.
4. Explain:
i. what possible impacts the fill would have on the Bay Area, including impacts on: (1) the volume of Bay waters, on Bay surface area, or on the circulation of Bay water; (2) water quality; (3) the fertility of marshes or fish or wildlife resources; and (4) other physical conditions that exist within the area, including land, air, water, minerals, flora, fauna, noise, or objects of historic or aesthetic significance; and
ii. how the nature, location, and extent of the fill would minimize possible harmful conditions or effects to the Bay.
5. For projects in subtidal areas that have an abundance and diversity of fish, other aquatic organisms and wildlife, or are scarce such as eelgrass beds and sandy deep water, identify feasible alternatives and public benefits associated with the project.
6. Explain: (a) why the fill would be the minimum amount necessary; and (b) why there is no alternative upland location for the project that would avoid the need for Bay fill.
7. If the fill is to be used for improving shoreline appearance or providing new public access to the Bay, explain why it is physically impossible or economically infeasible to accomplish these goals without filling the Bay.
8. Explain how the fill would result in a stable and permanent shoreline.
9. Explain the steps that would be taken to assure that the project will provide reasonable protection to persons and property against hazards of unstable geologic or soil conditions, of sea level rise, or of flood or storm waters.
10. Provide the names, addresses, and telephone numbers of any licensed geologists, engineers, or architects involved in the project design who can provide technical information and certify the safety of the project.
11. Describe in detail the anticipated impacts of the fill on the tidal and subtidal environment, and describe how these impacts would be addressed or mitigated, and explain how the public benefits of the project would clearly exceed the public detriment from the loss of water area, tidal marsh or tidal flats.
12. For marina projects, indicate how many berths, if any, are to be made available for live-aboard boats and explain how these live-aboard boats would contribute to public trust purposes.
13. For tidal, subtidal and other wetland restoration projects, including mitigation projects: (a) identify specific long-term and short-term biological and physical goals; (b) identify success criteria; (c) provide a monitoring program intended to assess the success and sustainability of the project; (d) include an adaptive management plan with corrective measures, if needed, to achieve success and sustainability; and (e) identify the provisions for long-term maintenance, as required by the Bay Plan policies on Mitigation, Tidal and Subtidal Areas. The Commission's laws and policies may be found at www.bcdc.ca.gov in the digital library.
Box 4 Shoreline Band Information
(“Shoreline band” means the land area lying between the Bay shoreline and a line drawn parallel to and 100 feet from the Bay shoreline. The Bay shoreline is the Mean High Water Line, or five feet above Mean Sea Level in marshlands.)
a. Does the project involve development within the 100-foot shoreline band around San Francisco Bay?
Empty Checkbox​ Yes Empty Checkbox​ No
If “Yes”, complete this box.
b. Types of activities to be undertaken or fill, materials or structures to be placed within the shoreline band:
 
 
 
c. Would the project be located within a priority use area designated in the San Francisco Bay Plan?
Empty Checkbox​ Yes Empty Checkbox​ No
The Bay Plan and Maps that depict priority use areas can be viewed in the digital library at www.bcdc.ca.gov.
If “No,” go to section (d). If “Yes,” please indicate which priority use the area is reserved for: __________
Would the project use be consistent with the priority use for which the site is reserved?
Empty Checkbox​ Yes Empty Checkbox​ No
If “Yes,” go to section (d). If “No,” attach an explanation of how the project can be approved despite this inconsistency
d. Total shoreline band area:
Within project site: __________ square feet
To be reserved for private, non-public access uses: __________ square feet
To be reserved for public access: __________ square feet
e. INFORMATION ABOUT WORK PROPOSED IN THE SHORELINE BAND (PROVIDE IN AN ATTACHMENT):
1. Provide dimensions of portions of all structures to be built within the shoreline band, including length, width, area, height, and number of stories.
2. Provide one or more photographs of existing conditions within the 100-foot shoreline band.
Box 5 Public Access Information
(must be completed by all applicants)
a. PUBLIC ACCESS DETAILS:
1. Does public access to the shoreline or do views to the Bay presently exist at the project site, at a contiguous property, or from nearby roads or public access areas?
Empty Checkbox​ Yes Empty Checkbox​ No
If “Yes”, attach a description of the existing public access and views at these areas.
If “No,” explain what is preventing public access to, or views of, the shoreline.
2. Describe how the project would or would not adversely impact present and future public access and views to the Bay. If so, describe how the proposed public access would offset the impact.
3. For most large projects, identify: (1) the existing number of people or employees using the site; and (2) the existing number of cars, bicycles, and pedestrians visiting the site and the level of service of all nearby roads leading to the site. Describe how the project would change these factors.
4. Identify the public's use of existing nearby parks, public access, public parking and other recreational areas on the shoreline and the roads leading to the site and describe the impact the project is expected to have on that use.
5. Do public safety considerations or significant use conflicts make it infeasible to provide new public access to the shoreline on the project site?
Empty Checkbox​ Yes Empty Checkbox​ No
If “Yes,” describe the public safety considerations or significant use conflicts that make it infeasible to provide public access at the project site and either: (1) identify an offsite area where public access to the shoreline is proposed as part of the project and describe the proposed public access area and improvements at that location; or (2) explain why no offsite public access is proposed as part of the project
6. Dimensions of the public access areas:
Empty Checkbox​ None Proposed
Existing
Proposed
Total public access area including areas outside BCDC's jurisdiction:
__________ square feet
__________ square feet
Public access within Commission's shoreline band jurisdiction:
__________ square feet
__________ square feet
__________ linear feet
__________ linear feet
__________ average width
__________ average width
Public access pathways, sidewalks in the shoreline band:
__________ square feet
__________ square feet
__________ linear feet
__________ linear feet
__________ average width
__________ average width
Public access area, landscaping in the shoreline band:
__________ square feet
__________ square feet
Public access on fill within Commission's Bay, certain waterways, and managed wetlands
__________ square feet
__________ square feet
jurisdiction:
__________ linear feet
__________ linear feet
__________ average width
__________ average width
Public access on piers or decks over water/wetlands:
__________ square feet
__________ square feet
__________ linear feet
__________ linear feet
__________ average width
__________ average width
View corridor(s):
__________ square feet
__________ square feet
__________ linear feet
__________ linear feet
__________ average width
__________ average width
Public access parking:
__________ stalls
__________ stalls
b. ADDITIONAL PUBLIC ACCESS INFORMATION (PROVIDE IN AN ATTACHMENT):
1. Describe the existing and proposed public access improvements, both on-site and off-site, including decks, piers, pathways, sidewalks, signs, benches, landscaping, parking, and any other proposed public improvements.
2. Describe how the public access area and facilities would be accessible to disabled persons.
3. Describe the proposed connections to existing public streets or offsite public pathways.
4. Specify how the public access areas would be permanently guaranteed (e.g., dedication, deed restriction, etc.) and how the areas and improvements would be maintained.
5. Describe the species present, wildlife use, and habitat conditions in and adjacent to the proposed public access areas and the likely type and degree of human use of the site (i.e., bicycling, dog walking, birding, frequency of use, etc.). Describe how any potential adverse effects on wildlife from public access would be avoided or minimized through the siting, design and management of the public access being proposed at the site.
Box 6 Dredging and Mining Information
a. Complete this box if the project involves mining, dredging or the disposal of dredged material in any of the following areas.
Empty Checkbox​ San Francisco Bay Empty Checkbox​ Salt pond Empty Checkbox​ Managed wetland Empty Checkbox​ “Certain waterway”
Empty Checkbox​ Primary management area of the Suisun Marsh Empty Checkbox​ Other: __________
b. Are you submitting a separate application to the Dredged Material Management Office (DMMO)?
Empty Checkbox​ Yes Empty Checkbox​ No
If “Yes,” attach a copy of that application; it is not necessary to complete this Box. If “No,” complete this box.
c. Type of activity: Empty Checkbox​ Maintenance Dredging Empty Checkbox​ New Dredging Empty Checkbox​ Mining
d. Method of dredging or mining:
 
 
e. Total volume and area of material to be dredged or mined from:
Open waters: __________ cubic yards __________ square feet
Tidal marshes: __________ cubic yards __________ square feet
Tidal flats: __________ cubic yards __________ square feet
Salt ponds: __________ cubic yards __________ square feet
Managed wetlands in the primary management area of the Suisun Marsh: __________ cubic yards __________ square feet
Other managed wetlands: __________ cubic yards __________ square feet
Subtidal areas that are scarce or have an abundance and diversity of fish, other aquatic organisms and wildlife, such as eelgrass beds and sandy deep water. __________ cubic yards __________ square feet
Other (specify): __________ cubic yards __________ square feet
f. Are knockdowns proposed as part of the dredging project?
Empty Checkbox​ Yes Empty Checkbox​ No
Number of knockdowns: __________
Volume per knockdown event: __________ cubic yards
g. Location(s) where dredged or mined material will be deposited:
h. Total volume of dredged material to be disposed of: __________ cubic yards
Beneficially re-used: __________ cubic yards
i. Estimated future maintenance dredging required annually: __________ cubic yards
j. For dredging projects:
Proposed design depths (MLLW): (1) __________(2) __________(3) __________
Proposed over-depth dredging (+ feet): (1) __________(2) __________(3) __________
Number of dredging episodes: __________
k. Does this project have an annual average dredging average of 50,000 cubic yards or less? Empty Checkbox​ Yes Empty Checkbox​ No
g. ADDITIONAL INFORMATION (PROVIDE IN AN ATTACHMENT):
1. If the dredged material is to be disposed of in the Bay, explain why the material cannot feasibly be beneficially re-used or disposed of in the ocean, upland, or inland outside of the Commission's jurisdiction.
2. Provide the results of testing for biological, chemical or physical properties of the material to be dredged.
3. Provide a copy of a water quality certification or waste discharge requirements for the dredging or disposal of dredged material from the San Francisco Bay Regional Water Quality Control Board.
4. Identify local and Bay-wide effects of the project on: (a) the possible introduction or spread of invasive species; (b) tidal hydrology and sediment movement; (c) fish, other aquatic organisms and wildlife; (d) aquatic vegetation; and (e) the Bay's bathymetry.
5. For projects in subtidal areas that have an abundance and diversity of fish, other aquatic organisms and wildlife, or are scarce such as eelgrass beds and sandy deep water, identify feasible alternatives and public benefits associated with the project.
Box 7 Information on Government Approvals
(must be completed by all applicants)
Required YES NO
Type Approval
Date Approval Expected/Received
Agency Contact and Phone Number
Local Government
Discretionary Approval(s):
Empty Checkbox​ Yes Empty Checkbox​ No
__________
__________
 
State Lands Commission:
Empty Checkbox​ Yes Empty Checkbox​ No
__________
__________
 
 
Regional Water Quality Control Board:
Empty Checkbox​ Yes Empty Checkbox​ No
__________
__________
 
Regional Board Number:
 
California Dept. of Toxic Substances Control:
Empty Checkbox​ Yes Empty Checkbox​ No
__________
__________
 
California Department of Fish and Wildlife Streambed Alteration Permit:
Empty Checkbox​ Yes Empty Checkbox​ No
__________
__________
 
DF&W Take Authorization:
Empty Checkbox​ Yes Empty Checkbox​ No
__________
__________
 
Other DF&W Permit:
Empty Checkbox​ Yes Empty Checkbox​ No
__________
__________
 
U.S. Army Corps Of Engineers:
Empty Checkbox​ Yes Empty Checkbox​ No
__________
__________
 
Public Notice Number:
 
U.S. Fish and Wildlife Service:
Take Authorization
Empty Checkbox​ Yes Empty Checkbox​ No
__________
__________
 
Biological Opinion:
Empty Checkbox​ Yes Empty Checkbox​ No
__________
__________
 
NOAA Fisheries Service:
Take Authorization
Empty Checkbox​ Yes Empty Checkbox​ No
__________
__________
 
Biological Opinion
Empty Checkbox​ Yes Empty Checkbox​ No
__________
__________
 
U.S. Coast Guard:
Empty Checkbox​ Yes Empty Checkbox​ No
__________
__________
 
Federal Funding:
Empty Checkbox​ Yes Empty Checkbox​ No
__________
__________
 
Other Approval (Specify):
__________
__________
 
Box 8 Environmental Impact Documentation
(must be completed by all applicants)
a. Is the project statutorily or categorically exempt from the need to prepare any environmental documentation?
Empty Checkbox​ Yes Empty Checkbox​ No
If “Yes,” please attach a statement that identifies and supports this statutory or categorical exemption.
b. Has a government agency other than BCDC, serving as the lead agency, adopted a negative declaration or certified an environmental impact report or environmental impact statement on the project?
Empty Checkbox​ Yes Empty Checkbox​ No
If “Yes,” attach a copy of the document. If the environmental impact report or statement is longer than ten pages, also provide a summary of up to ten pages. If “No,” provide sufficient information to allow the Commission to make the necessary findings regarding all applicable policies. The certified document must be submitted prior to action on the permit.
Box 9 Public Notice Information
(must be completed by all applicants)
a. Owners and residents of all properties located within 100 feet of the project site (if more than four, provide the information electronically):
North:
Name: ____________________
Address: ____________________
City, State, Zip: ____________________
Telephone: __________/____________________/__________
South:
Name: ____________________
Address: ____________________
City, State, Zip: ____________________
Telephone: __________/____________________/__________
East:
Name: ____________________
Address: ____________________
City, State, Zip: ____________________
Telephone: __________/____________________/__________
West:
Name: ____________________
Address: ____________________
City, State, Zip: ____________________
Telephone: __________/____________________/__________
b. Other persons known to be interested in this project: (if more than two, provide the information electronically). Empty Checkbox​ None
Name: ____________________
Address: ____________________
City, State, Zip: ____________________
Telephone: __________/____________________/__________
Name: ____________________
Address: ____________________
City, State, Zip: ____________________
Telephone: __________/____________________/__________
Checklist of Application Requirements
(For Applicant's Use)
Major Permit
Administrative Permit
Regionwide Permit
Empty Checkbox​
Application Form
One fully completed and signed original and seven copies
One fully completed and signed original
One fully completed and signed original
Empty Checkbox​
Large Scale Project Site Plan
One copy
One copy
One copy
Empty Checkbox​
8.5″x11″ Project Site Plan
Seven copies
One copy
One copy
Empty Checkbox​
*8.5″x11″ Public Access and Open Space Plan
Seven copies
One copy
None
Empty Checkbox​
8.5″x11″ Vicinity Map
Seven copies
One copy
One copy
Empty Checkbox​
Proof of Legal Property Interest
One copy
One copy
One copy
Empty Checkbox​
Local Government Discretionary Approval
One copy
One copy
None
Empty Checkbox​
Environmental Documentation
One copy of environmental determination and EIR or EIS Summary
One copy of environmental determination
None
Empty Checkbox​
Water Quality Certification/Waiver
One copy, if applicable
One copy, if applicable
One copy, if applicable
Empty Checkbox​
Dept. of Toxic Substances Control Approval
One copy, if applicable
One copy, if applicable
One copy, if applicable
Empty Checkbox​
Biological Opinion/Take Authorization from state and federal agencies
One copy, if applicable
One copy, if applicable
Empty Checkbox​
Application Processing Fee
As specified in Commission regulations, Appendix M
As specified in Commission regulations, Appendix M
As specified in Commission regulations, Appendix M
Empty Checkbox​
*Notice of Pending Application
Posted at project site
Posted at project site
Posted at project site
Empty Checkbox​
*Certification of Posting the Notice of Application
One signed original returned to BCDC
One signed original returned to BCDC
One signed original returned to BCDC
* BCDC staff will provide the forms for posting the Notice of Application and the Certification.
The provisions of this form are self-explanatory and no other instructions are applicable.

Credits

Note: Authority cited: Sections 66632, Government Code; and Section 29201(e), Public Resources Code. Reference: Sections 65940-65942, 66605, 66632(b), 66632(f) and 84308, Government Code; Sections 2770, 2774, 21080.5, 21082, 21160 and 29520, Public Resources Code; and the San Francisco Bay Plan.
History
1. New Appendix D filed 5-18-87; operative 6-17-87 (Register 87, No. 30).
2. Amendment of appendix and new Note filed 2-2-98; operative 3-4-98 (Register 98, No. 6).
3. Amendment of appendix and Note filed 7-11-2000; operative 7-11-2000 (Register 2000, No. 28).
4. Repealer and new Appendix D filed 9-11-2008; operative 10-11-2008 (Register 2008, No. 37).
5. Change without regulatory effect amending and relocating Appendix D from chapter 17 to chapter 24 filed 12-31-2020 pursuant to section 100, title 1, California Code of Regulations (Register 2021, No. 1). (OAL review extended 60 calendar days pursuant to Executive Order N-40-20.)
This database is current through 6/21/24 Register 2024, No. 25.
Cal. Admin. Code tit. 14, Div. 5 App. D, 14 CA ADC Div. 5 App. D
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