FORM L&WD-2/PERMIT APPLICATION

FORM L&WD-2/PERMIT APPLICATION 8. Date activity is proposed to start , be completed 9. Classification of minor or major permit. Check one: ❑Minor Permit Application Major Permit Application State below which criterion applies in making above check. 10. Application is hereby made for a permit to authorize the activities described herein. I agree to provide any additional information/data that may be necessary to provide reasonable assurance or evidence to show that the proposed project will comply with the applicable territorial water quality standards or other environmental protection standards both during construction and after the project is completed. I also agree to provide entry to the project site for inspectors from the environmental protection agencies for the purpose of making inspection regarding this applicaton and that to the best of my knowledge and belief, that such information provided herein, is true, complete and accurate. I further certify that I possess the authority to undertake the proposed activities. Signature of Applicant or Agent Date Signature of Owner (Where Applicant or Agent is not Owner) FOR DEPARTMENT USE ONLY Inspector Record Date Inspected: ( )Permit Approved ( )Permit Disapproved Inspector's Remarks: Inspector Date Commissioner, Planning & Natural Resources Date EFTA00802930 GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF PLANNING AND NATURAL RESOURCES DEVELOPMENT PERMIT APPLICATION FORM L&WD-5 PROOF OF LEGAL INTEREST AFFIDAVIT , being duly sworn depose and say that: Name I. I am the (check one) Dtecord title owner (fee simple) ElLessee l 0ther (specify) of the real property described as Parcel No(s) Estate Quarter Island 2. I have the irrevocable approvals, permission, or power of attorney from all other persons with a legal interest in the property to undertake the work proposed in the permit application as more fully set forth in the exhibit (s) attached hereto: The foregoing instrument was acknowledged before me this day of 20 by at county of Notary Public My Commission expires EFTA00802931 GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES -0- VIRGIN ISLANDS BUREAU OF INTERNAL REVENUE (DPNR FORM L&WD-6) APPLICATION FOR TAX FILING AND PAYMENT STATUS REPORT** Date: The applicant identified below hereby requests a letter certifying his or her tax filing and payment status for the purpose of receiving a Coastal Zone Management Permit from the Virgin Islands Department of Planning and Natural Resources pursuant to Act 5270, amending Sections 910 (aX2) and 911 (dX2) of the Coastal Zone Management Act (Title 12, Chapter 21, Virgin Islands Code). The applicant authorizes the Bureau of Internal Revenue to disclose any taxpayer information necessary to process this application to the Virgin Islands Department of Planning and Natural Resources, who may make such further disclosures as are necessary to carry out the requirements of the Coastal Zone Management Act, as amended. Name: Business Name: EINCHN: SSN: please Indicate: •Corporation Type of Business: *Partnership ri Individual Please circle forms that you use: 1120, 1120s, n Other 1065,1040, 941 VI, 722 VI, 720, 720 VI, 720 BVI, 50VI, other (list) Date Business Started: Person Representing Applicant: Position: Signature: Mailing Address: Date: Telephone Number: Reply to: 9601 Estate Thomas, St. Thomas VI 00802 or 4008 Estate Diamond, St. Croix VI 00820 * Partnerships and/or Corporations must list partners/ corporate officers, social security numbers and addresses on a seperate sheet and attach it to this application. EFTA00802932