Fillable MFS PERMIT BY RULE NOTIFICATION FORM DEPARTMENT OF (State of Maine)

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MFS PERMIT BY RULE NOTIFICATION FORM DEPARTMENT OF (State of Maine)

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3/25/2016 - Previous versions not valid
DEPARTMENT OF AGRICULTURE CONSERVATION AND FORESTRY
MFS PERMIT BY RULE NOTIFICATION FORM
For use with MFS Chapter 21 Rule, Statewide Standards for Timber Harvesting and Related Activities in Shoreland Areas
Meets the requirements for NPRA permit by rule for TIMBER HARVESTING RELATED ACTIVITES ONLY
PLEASE TYPE OR PRINT CLEARLY IN BLACK OR BLUE INK ONLY
Name of Applicant:
(landowner)
Name of Agent:
Applicant Mailing
Address:
Agent Phone # (include
area code):
Town/City:
PROJECT Information
Name of Town/City:
State and Zip code:
Name of Wetland or
Waterbody:
Daytime Phone #
(include area code):
Map #: Lot #:
Detailed Directions to Site:
UTM Northing:
(if known)
UTM Easting:
(if known)
Part of a larger project?
Yes
No
After the Fact?
(check one)
Yes
No
Check one
This project does (or) does not involve work
below mean low water (average low water).
PERMIT BY RULE (PBR) SECTIONS: (Check at least one)
I am filing notice of my intent to carry out work which meets the requirements for Permit by Rule (PBR) under MFS Rules,
Chapter 21. I and my agents, if any, have read and will comply with all of the standards in the Sections checked below.
NRPA Sec. (2) Adj. to Protected Natural Res. SWS CH. 21 Sec. (11) Stream Crossing
NOTIFICATION FORMS CANNOT BE ACCEPTED WITHOUT THE NECESSARY ATTACHMENTS:
Attach a check for the correct fee, payable to: "Treasurer, State of Maine." The current fee for MFS PBR
Notifications is $74.00.
Attach a U.S.G.S. topo map or Maine Atlas & Gazetteer map with the project site clearly marked.
Attach Proof of Legal Name if applicant is a corporation, LLC, or other legal entity. Provide a copy of
Secretary of State’s registration information (available at http://icrs.informe.org/nei-sos-icrs/ICRS?MainPage=x ).
Individuals and municipalities are not required to provide any proof of identity,
Attach all other required submissions as outlined in the PBR Sections checked above.
I authorize staff of the Maine Forest Service to access the project site for the purpose of determining compliance with the
rules. I also understand that this permit is not valid until accepted as complete by the Maine Forest Service.
By signing this Notification Form, I represent that the project meets all applicability requirements and standards in
the rule and that the applicant has sufficient title, right, or interest in the property where the activity takes place.
Signature of Agent or
Applicant:
Date:
Keep a copy as a record of permit. Send the form with attachments via certified mail or hand deliver to the Maine Forest Service at
the office listed below. The MFS will send a copy to the town office as evidence of the MFS's receipt of notification. No further
authorization by MFS will be issued after receipt of notice. Permits are valid for two years. Work carried out in violation of any
standard is subject to enforcement action.
MAINE FOREST SERVICE
ATTN: PBR
22 STATE HOUSE STATION
AUGUSTA, MAINE 04333-0022
207-287-2791
OFFICE USE ONLY
Ck.#
Staff
Staff
PBR # FP Date Acc.
Date
Def.
Date
After
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MFS PERMIT BY RULE NOTIFICATION FORM DEPARTMENT OF (State of Maine)

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Completed 20 July 2020

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