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PUBLIC NOTICE TEMPLATE <br />complete this tetePlate using project -speck information and submit to a local newspaper with general <br />maculation within Se county where the project is located. The bold language is required by WAC 173-226- <br />i30 and must belnciuded In its entirety. (Either use the fill-in template below or attach on a separate sheet <br />of paper, If nocessary.) <br />(Note: Th/s sordeo't is unprotected .• you can delete text in parentheses) <br />Axtheim Constnetion PO Box 2947, Mount Vernon, WA 98273Is seeking coverage <br />under the Washington Stale Department of Ecology's Construction Stormwater General Permit <br />The proposed project, Bob's Buroer(and Brew , Is located at 1605 Southwest Everett Mail Way In <br />Everett WA.__ _._____ , in Snohomish County. <br />This project involves 1.26 _acres of sell disturbance for commercial construction activities. <br />Stornwater will be disc)•uRjMt' AnWFFmed tributary flowing to Silver Lake <br />Any persons desiri's^ Present Ihbli YtB+sto tpe r <br />,,,t, ' Department of Ecology regarding this application, <br />or interested in S" 'l" ItornInt's action ; "�I(cation, may notify Ecology In writing within 30 <br />days of the las'u1r� or publlcall,•llh o} thu. `"Nee. D""'' <br />Comments ^ny be submitted to: Departmeeof Ec-'• qy <br />Water Quatej Proi <br />1p 0, pPz 016 <br />Olympia, Wh 9f3Of ?496 <br />vin. certification of Pormitteas <br />"1 certify under penal0• of lmr that this dacunton and all utmchntents were prepared under my direction or , <br />i supervision in accordance with a system designed to assure that gtmltfred personnel properly gather and evaluate <br />the information submined. Based cot nny inquiry of the person or persons u•ho manage the.nstem or those directly <br />respotslhlefrm gathering the it jannation. the information submitted Is, to the best of my knowledge and belief, <br />I true, accuram. and complete. 1 con aware that there arc si;nifrcant pettalifs jar submitting false h Jormatlom. <br />including do possibili0• offnnc ord intprisoumenrfor kaowa:g ylolaiions. " <br />Printed Name / Company Title <br />Signature • Ott <br />Federal regulations require this application Is signed by one of the following: <br />A. For a corporation: By a principal executive officer of at least the level of vice president. <br />B. For a partnership or sole proprietorship: By a general partner or the proprietor, respectively. <br />C. For a municipality, state, federal, or other public facility: By either a principal executive officer or <br />ranking elected official. <br />Please sign and return this document to the following address: <br />Washington Department of Ecology - Stormwahn <br />P.O. Box 47696 <br />Olympia, WA 98504-7696 <br />