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(check one)
per referral/advisory agency notice
I, we, DECLINE coverage pursuant to the SJMSCP. I, we, understand that declining coverage pursuant to the SJMSCP will require undertaking negotiations with the Local Jurisdiction and Permitting Agencies to avoid potential significant adverse impacts to biological resources where such impacts may occur. I, we, verify that the information contained in this application is true and correct.
I, we, REQUEST coverage pursuant to the SJMSCP. I, we, understand that this project may be subject to Habitat Technical Advisory Committee review and approval to gain coverage pursuant to the SJMSCP and that signing this form constitutes authorization for SJCOG, Inc. representatives to enter the subject property for the purposes of assessing biological resources and compliance with the SJMSCP. I, we, verify that the information contained in this application is true and correct.
I certify that all statements on this form are true and complete to the best of my knowledge and belief. I understand that any falsification of the information on this form may, if I am accepted, be considered grounds for immediate dismissal.
(including those opting OUT of the SJMSCP)
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