Type of Application
Application Contact Information:
Application Contact Information:
Home Phone
Home Phone
Work Phone
Work Phone
Property Owner Contact Information:
Property Owner Contact Information:
Builder Phone:
Builder Phone:
Is the property subject to any easements or deed restrictions?
WITHIN 200’ OF SHORELINE?
(In Feet)
In Flood Plain
(In Feet)
PROPOSED SET-BACKS TO PROPERTY LINES:
TYPE OF WORK :
(CHECK ALL THAT APPLY)