WATER QUALITY PERMIT APPLICATION

Water Division

Ken Fetcho
Assistant Director
kfetcho@yuroktribe.nsn.us (707)-954-1523 cell
707-482-1822 x 1002 office

Micah Gibson
Environmental Specialist
Hydrology mgibson@yuroktribe.nsn.us (707) 954-1996 cell
(707) 482-1822 x 1004 office

Bill Patterson
Environmental Specialist
Wetlands wpatterson@yuroktribe.nsn.us (707)954-1865 cell
(707) 482-1822 x 1001 office

Scott Sinnott
Environmental Specialist
Water Quality ssinnott@yuroktribe.nsn.us (707)-954-1337 cell
(707) 482-1822 x 1003 office



Yurok Tribe
Klamath Office
15900 Hwy 101 N
PO Box 1027
Klamath, CA 95548


Water Quality Permit Application


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Water Quality Certification and/or Waste Discharge Requirements (Dredge/Fill) Download the Application Instructions & Project Plan Checklist

Please fill out form below and submit for approval.


1. APPLICANT

Property Owner

Owner's Representative

Address

Phone Email
Fax (optional)

2. PROJECT INFORMATION

Project Description and Purpose (see checklist for guidance)
Download the Application Instructions & Project Plan Checklist Now

Project Location


List other Federal Permit Application(s) and/or approved permits for which you have applied for or received (i.e. Army Corps of Engineers 404 Permit). Include whether permit is individual or nationwide and/or permit number. Mail file and/or application to the address indicated at the bottom of this application.






Compliance with applicable Tribal regulations





2. AFFECTED WATERS

Acres of water body affected by project(i.e. jurisdictional wetlands, riparian zone, streambed, and/or lake).
Please list separately and mail the permanent and temporary acres to be impacted as well as a detailed map illustrating extent of impact).


Name, title, and affiliation of person delineating Extent of Waters of U.S. (include wetland delineator certification information if applicable).


Describe proposed measures to avoid or mitigate direct impacts to Waters of US: (if direct impacts are unavoidable, describe efforts to minimize or mitigate impacts. See Mitigation Checklists for guidance)


Type and volume of proposed discharge (i.e. dredged or fill material)


Describe proposed measures to avoid or mitigate indirect impacts to Waters of the State: (i.e. upland impacts which might affect water quality. See Mitigation Checklists for guidance).


Describe proposed measures to avoid or mitigate indirect impacts to Waters of the State: (i.e. upland impacts which might affect water quality. See Mitigation Checklists for guidance).


Cumulative Impacts: Brief list/description of applicant’s previous and future projects related to the proposed activity or that may impact the same receiving water body/bodies.


Nearest Receiving Water(s) (or surface drainage)


Proposed Minimum Erosion Control Measures


4. SIGNATURES

Signature or Owner, Owner’s Representative or agency representative:



Date:

Please mail the appropriate fee and documentation to:
Attn: Ken Fetcho PO Box 1027 Klamath, CA 95548


For more information on the permit application process, please contact YTEP Assistant Director, Ken Fetcho at 707-482-1822 ext 1002 or kfetcho@yuroktribe.nsn.us


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