COASTAL APPLICATION FOR A MAJOR SITING PERMIT

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1 Frank M. Rabauliman Administrator Commonwealth of the Northern Mariana Islands OFFICE OF THE GOVERNOR Bureau of Environmental and Coastal Quality Division of Coastal Resources Management Gualo Rai Center Suite 305, Middle Road P.O. Box 10007, Saipan, MP Tel: (670) ; Fax: (670) Frances A. Castro Director, DCRM COASTAL APPLICATION FOR A MAJOR SITING PERMIT PROJECT LOCATION: Street Village Island DCRM OFFICE USE ONLY Received by: Owner s Name: DBA: Coastal Permit No.: Mailing Address Island Zip Code Date Received Date Distributed Name of Contractor or Authorized Representative (if any): 60 Days Deadline Date: Address : Type of land : Receipt No.: Date of Receipt: Public Private Telephone No. Contact: Amount Paid: Funding Source. Check all that apply. Individual Business CNMI Federal *See page 4 for the definition. *Estimated Project Cost: Date Certified Complete: A coastal permit is required to perform work regulated by the provisions of Chapter of Public Law New Amendment (Complete pages 1 thru 4 only) Page 1 8/2015

2 A. OTHER CNMI OR FEDERAL REGULATORY REQUIREMENTS REQUIRED TO PROPOSED ACTION: 1. Type of permit(s) which have been received or applied for to date. Permitting Agency Approval Date a. Zoning Law (Saipan) b. Dept. of Public Lands Lease c. DLNR: Submerged Lands Lease d. Federal (if applicable) i. Endangered Species Act ii. NEPA Compliance iii. iv. Clean Water Act (U.S.ACOE) Section 401 Water Quality Cert. 2. To the best of your knowledge, have you or any previous owner(s) filed an application for and/or received a CRM permit for any activity on this property? If yes, please provide permittee s name and permit number or date filed if available. Name Permit No 3. Is your project site partially or wholly within an Area of Particular Concern (APC)?. If so, which APC? Wetland and Mangrove APC Coastal Hazard APC Shoreline APC Ports & Industrial APC Lagoon & Reef APC 4. Is your project going to be situated on a body of water? Yes No 5. Is your project going to be situated on a wetland? Yes No Is it a jurisdictional or local wetland? Page 2 8/2015

3 6. List of adjacent property owners. Provide copies of Letter of Notification. Name Mailing Address Method of Notification CERTIFICATION By signing this application form, the applicant acknowledges that it has reviewed the CNMI Coastal Resources Management policies, and has, where possible, adhered to the policies and standards of the program, and that the information contained in the application and other attached documents associated with the project are true and valid. Information provided to DCRM for this application review which appear to be inaccurate or incomplete may be considered as an unacceptable submission. The applicant also understands that any false statements may be considered grounds for permit denial, revocation, and/or a civil fine of up to but not exceeding $10,000 per violation per day, 2 CMC 1534(d). I, declare that the foregoing submission is true and correct to the best of my knowledge. Further, I certify that I am qualified and authorized to file this document. Executed on this day of, 20. Signature of Owner or Authorized Representative Page 3 8/2015

4 DCRM PERMIT FEE SCHEDULE NMIAC (f) (Fees) (Please make payment at the CNMI Treasury office and provide a copy of receipt to DCRM) FEE AMOUNT COST OF PROJECT $200. less than or equal to $ 50,000 $400. value between $ 50,001 and $100,000 $1,000. value between $100,001 and $500,000 $2,000. value between $500,001 and $1,000,000 $2,000. plus an additional amount equal to the fee for the cost increment exceeding $1,000,000. All fees shall be based upon appraisal of construction costs for structures affixed to the ground. STATEMENT OF DISCLOSURE AND APPLICANT AGREEMENT OF PERMIT FEES If DCRM determines that the calculation of construction costs was in error at the time of submission, a new calculation shall be required. The applicant understands that additional fees may be assessed by DCRM. The applicant understands the above conditions and agrees to comply with them. Signature Date Print Name Title Page 4 8/2015

5 Below is an outline of the information you are required to include or to be addressed in the ENVIRONMENTAL IMPACT ASSESSMENT (EIA). A. SITE EVALUATION, ASSESSMENT, AND PLANNING 1. Location & Current Condition 2. Property Identification & Ownership 3. Current Land Use 4. Description of Adjacent Properties 5. Describe if project site has historical or cultural properties that may be affected by the project 6. Alternative Site(s) Include description, lot numbers, ownership, and maps 7. Vulnerability Assessment of Project Site to: a. Fault Line b. Flood Severity/Coastal Inundation c. Coastal Erosion/Shoreline Change, if applicable 8. Wildlife and Habitat Inventory 9. Site Maps/Vicinity Maps (indicate site boundaries on existing USGS topographic map and most recent aerial imagery) 10. Topographic map B. PROJECT EVALUATION, ASSESSMENT, AND PLANNING 1. Project Name. 2. Complete description of property. 3. Include description of existing environment of site including vegetation, wildlife and the direct, indirect and cumulative environmental effects which may result from the project. 4. Description of socio-economic characteristics of the project including income and employment, education, law enforcement, fire protection, hospital, and medical facilities. 5. Discussion of alternatives to the proposed project size/design and how the preferred alternative was selected. 6. Evaluation of the proposed project based on the Specific Criteria for Major Sitings provision of , and a description of how those specific criteria will be affected by the project. 7. Indicate whether the proposed project is to be connected to the public utilities systems (All utility load calculations must be certified by a CNMI-registered professional engineer). a. Sewage Generation i. Will the proposed project be connected to a public sewage system? ii. If not, how do you propose to discharge sewage generated? Page 5 8/2015

6 iii. How far is the public sewage line from the project site? iv. What is the expected amount of sewage will the proposed activities generate? b. Power Demand and Usage i. What will be the power demand be for the completed project? Average Peak ii. Is power available at site? iii. What is the size and operational schedule of any on-site generators during operations? Fuel storage tank sizes? iv. What is the estimated construction power requirement? (Indicate if this will increase by phases) c. Water Demand i. What is the source of water for the completed project? ii. What is the estimated water demand for the completed project? Average Peak iii. Will a desalination unit be used for this project? iv. How will wastewater from water treatment systems be disposed? 8. Include Traffic Impact Analysis done by a CNMI licensed professional engineer, if required by DPW. 9. Management Measures and Practices. a. Erosion and Sediment Controls i. Total land area to be cleared or developed (English system) ii. Geotechnical Report(s) b. Pollution Prevention Standards i. Solid Waste Management Plan ii. Air Quality and Noise Pollution Control Measures c. Climate Smart Planning i. Flood Severity and Coastal Inundation Concerns ii. Renewable Energy Siting Alternatives d. Mitigation Measures i. Public Access Concerns, if applicable ii. Ecological Concerns (Terrestrial, Coastal, & Marine) iii. Setbacks for hazardous lands including floodplains, erosion-prone areas, storm wave inundation areas, air installation crash and sound zones, and major fault lines, if applicable C. OTHER REQUIRED DOCUMENTS 1. Master Site Development Plan i. Architectural features, infrastructure and project amenities; ii. Floor Plans in conceptual format for all structures; iii. View Corridor Plan (See NMIAC (c)(1)(ii)(High Rise Development); Page 6 8/2015

7 iv. Site Layout Plan displaying lot density including buildings, infrastructure, amenities, parking area, road networking, and open space; v. Existing Conditions Map; vi. Watershed and drainage map; vii. Conceptual erosion control and drainage plans: Slope and elevation map; Preliminary drainage and erosion control map; and Preliminary storm water nonpoint source management plan. viii. A USGS topographic map showing the distance of project site from closest APCs. Page 7 8/2015

8 NOTICE TO THE APPLICANT It is the responsibility of the applicant to submit all required supporting documents to DCRM. DCRM regulations for Major Siting Permits require that the following MUST accompany every application otherwise application will be deemed incomplete. A pre-application conference shall be held to discuss the proposed activity prior to submission to provide the applicant with information pertaining to the CRM program and to answer questions the applicant may have regarding the CRM program and its requirements. 1. Copies. The applicant shall file an original DCRM application with exhibits and attachments, one (1) electronic copy and eight (8) hard copies thereof; 2. File Location. CRM permit applications shall be filed at the DCRM office in Saipan. Proposed projects on Tinian or Rota may be filed at the respective DCRM Branch office; 3. Certification. CRM permit applications shall be signed and dated by the applicant that the information supplies in the application and its exhibits and attachments are true; 4. Supporting attachments and exhibits pertaining to the proposed project and project site as follows: a. Statements b. Drawings c. Maps d. Permits & Clearances from other agencies (HPO, DEQ, DFW, Zoning, DPL) e. Other documents as may be necessary for thorough review to be determined by DCRM. 5. Application Fee (see attached DCRM Fee Schedule for application fee amount) 6. Proof of Ownership (Lease/Rental Agreement & Business License) In addition, where these additional items are applicable, they are also required: a. Affirmation that the proposed structure will be connected to CUC s power, sewer, and water service. Your application will be thoroughly reviewed by DCRM technical advisors. You will be notified if additional information is required to complete this review. To avoid further delays in processing your permit application, you are strongly encouraged to fully provide all necessary information and to adhere to all Coastal Resources Program requirements. Page 8 8/2015

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