Notification of Work in Watersheds Form A. Applicant Information Processing 1a. Specify Nationwide Permit (NWP) number: or General Permit (GP) number: 1b. Has the NWP or GP number been verified by the Corps? Yes No 1c. Does the project meet all the Conditions of the applicable Water Quality Yes No Certification Please note that your project may be subject to the Sediment and Erosion Control Program and/or Trout Buffers implemented by the Division of Energy, Mineral, and Land Resources. Find more info at: https://deq.nc.gov/about/divisions/energy-mineral-land-resources/erosion-sediment-control Project Information 2a. Name of project: 2b. County: 2c. Nearest municipality / town: Information 3a. Name(s) on Recorded Deed: 3b. Responsible Party (for LLC if applicable): 3c. Street address: 3d. City, state, zip: 3e. Telephone no.: 3f. Email address: 4. Agent/Consultant Information (if applicable) 4a. Name: 4b. Business name (if applicable): 4c. Telephone no.: 4d. Email address: B. Project Information Property Identification 1a. Property identification no. (tax PIN or parcel ID): Latitude: Longitude: - 1b. Site coordinates (in decimal degrees): (DD.DDDDDD) (-DD.DDDDDD)
Notification of Work in Watersheds Form A. Applicant Information Processing 1a. Specify Nationwide Permit (NWP) number: or General Permit (GP) number: 1b. Has the NWP or GP number been verified by the Corps? Yes No 1c. Does the project meet all the Conditions of the applicable Water Quality Certification Yes No Please note that your project may be subject to the Sediment and Erosion Control Program and/or Trout Buffers implemented by the Division of Energy, Mineral, and Land Resources. Find more info at: https://deq.nc.gov/about/divisions/energy-mineral-land-resources/erosion-sediment-control Project Information 2a. Name of project: 2b. County: 2c. Nearest municipality / town: Information 3a. Name(s) on Recorded Deed: 3b. Responsible Party (for LLC if applicable): 3c. Street address: 3d. City, state, zip: 3e. Telephone no.: 3f. Email address: 4. Agent/Consultant Information (if applicable) 4a. Name: 4b. Business name (if applicable): 4c. Telephone no.: 4d. Email address: B. Project Information Property Identification 1a. Property identification no. (tax PIN or parcel ID): 1b. Site coordinates (in decimal degrees): Latitude: Longitude: - (DD.DDDDDD) (-DD.DDDDDD)
TroutWS11-2017_Form.docx