"Request for Authorization Form for the State of Delaware Statewide Activity Approval for Construction in Tidal Artificial Lagoon Systems" - Delaware

Request for Authorization Form for the State of Delaware Statewide Activity Approval for Construction in Tidal Artificial Lagoon Systems is a legal document that was released by the Delaware Department of Natural Resources and Environmental Control - a government authority operating within Delaware.

Form Details:

  • Released on August 19, 2009;
  • The latest edition currently provided by the Delaware Department of Natural Resources and Environmental Control;
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Expiration Date: ____________
REQUEST FOR AUTHORIZATION FORM
FOR THE STATE OF DELAWARE
STATEWIDE ACTIVITY APPROVAL FOR
CONSTRUCTION IN TIDAL ARTIFICIAL
LAGOON SYSTEMS
Applicant Name and Address
Contractor Name and Address
Applicant Phone __________________ Contractor Phone __________________
_________
a) Community/Development Name:
Site Address
____________________________________________
b) Name of natural waterbody that lagoon connects to:
____________________________________________
c) Lagoon width at project site: ___________ ft. (See
Definitions, p. 6)
d) Tax Parcel #_________________________________
Structure Type
Dimensions (ft.)
New
Repair
# of Each
L
W
L
W
L
W
L
W
L
W
L
W
Applicant’s Signature: ____________________________
Date: _____________________
I hereby certify that the information on this form and on the attached plans are true and accurate to the best of my knowledge. I understand that the
Department may request information in addition to that set forth herein if deemed necessary to appropriately consider this application. I grant
Permission to the authorized Department representative(s) to enter upon the premises for inspection purposes during working hours.
Contractor’s Signature: ___________________________
Date: _____________________
I hereby certify that the information on this form and on the attached plans are true and accurate to the best of my knowledge. I understand that the
Department may request information in addition to that set forth herein if deemed necessary to appropriately consider this application.
Owner of Underwater
Land’s Signature:
_____________________________
Date: _____________________
Manager’s Signature: ______________________________
Date:__________________
Expiration Date: ____________
REQUEST FOR AUTHORIZATION FORM
FOR THE STATE OF DELAWARE
STATEWIDE ACTIVITY APPROVAL FOR
CONSTRUCTION IN TIDAL ARTIFICIAL
LAGOON SYSTEMS
Applicant Name and Address
Contractor Name and Address
Applicant Phone __________________ Contractor Phone __________________
_________
a) Community/Development Name:
Site Address
____________________________________________
b) Name of natural waterbody that lagoon connects to:
____________________________________________
c) Lagoon width at project site: ___________ ft. (See
Definitions, p. 6)
d) Tax Parcel #_________________________________
Structure Type
Dimensions (ft.)
New
Repair
# of Each
L
W
L
W
L
W
L
W
L
W
L
W
Applicant’s Signature: ____________________________
Date: _____________________
I hereby certify that the information on this form and on the attached plans are true and accurate to the best of my knowledge. I understand that the
Department may request information in addition to that set forth herein if deemed necessary to appropriately consider this application. I grant
Permission to the authorized Department representative(s) to enter upon the premises for inspection purposes during working hours.
Contractor’s Signature: ___________________________
Date: _____________________
I hereby certify that the information on this form and on the attached plans are true and accurate to the best of my knowledge. I understand that the
Department may request information in addition to that set forth herein if deemed necessary to appropriately consider this application.
Owner of Underwater
Land’s Signature:
_____________________________
Date: _____________________
Manager’s Signature: ______________________________
Date:__________________