Application for Activities and Land Use Permit (cont.)
4. Is approval by the Department of Environmental Protection required before
beginning any work on this project? (If yes, you must furnish a copy of the approval)
Yes No
5. Is approval by Army Corp of Engineers required before beginning any work on this
project? (If yes, you must furnish a copy of the approval) Yes No
6. DIG SAFE 888-344-7233 Yes No
7. Name & Address of Contractor (must be certified in erosion control practices
through DEP and provide certificate # if working in Shoreland Zone.)
__________________________________________________________________________________________
__________________________________________________________________________________________
8. Will the proposed work require blasting? Yes* No * If yes, a Blasting Permit is
required.
*If the work to be done is in the Shoreland or Resource Protection Zone, the
owner/applicant must supply all information required under Article 5 of the Land Use
Ordinance.
*Attach or draw a site plan showing the size and location of all the construction, distances
from lot lines, and the established streets, distances from marsh, water, brooks, ponds and
wetlands. The undersigned certifies that the information on this permit is accurate.
______________________________________ _______________________________________
Owner Date Applicant Date
*
*****************************************************************************
Approved ______ Denied ________
$_______________________ __________________________________________
Permit Fee Code Enforcement Officer Date
__________________________________________
Highway Superintendent Date
(Necessary for curb cut)
__________________________________________
Police Chief Date
(Necessary for curb cut)
