Balcones Canyonlands Conservation Plan
Participation Certificate Application
Mitigation Fee Zone Determination
Application No. __________________
1. Applicant Information:
Applicant Name: ____________________________________________________________________
Company or Agency: _________________________________________________________________
Mailing Address: ____________________________________________________________________
City: _________________________ State: ____________ Zip Code: _______________
Contact Name: ___________________________ Contact Title: ______________________________
Daytime Phone # (____) ____-______ Fax # (____) ____-______
2. Landowner (if different from Applicant): _______________________________________________
Mailing Address: ____________________________________________________________________
City: _________________________ State: ____________ Zip Code: _______________
3. Property Name _____________________________________________________________________
Street Address or Location ___________________________________________________________
4. Legal Description:
Subdivision _______________________________________ Lot(s) ______________________
Block________ Phase__________ Section_________
Acres________ Out of___________________________________ Survey # _______________
5. Tax Parcel ID #’s ___________________________________________________________________
6. Has the U.S. Fish and Wildlife Service (USFWS) determined mitigation requirements or potential take
of listed species for this property or a portion thereof? *YES____ or NO____
* If YES, attach a copy of the calculations and any related correspondence from USFWS.
7. Have mitigation fees or participation fees been paid on this property? *YES____ or NO____
* If YES, attach appropriate documentation and any proof of money transactions.
8. Is this application for one single family lot (Special Provision Certificate)? *YES____ or NO____
* If YES, attach evidence that the tract was legally recorded as a single parcel in Travis
County on or before May 4, 1990.
9. Is this application for the Land in Lieu of Fees Provision? *YES____ or NO____
BCCP Application Form Page 1 of 2
Revised 6-13-08
