Coastal Zone Land Alteration Request Form
Applicant Name
Organization (if applicable)
Contact Information
Project Title
Project Location
Parcel Number / Land ID
Type of Alteration
Excavation
Filling
Construction
Vegetation Removal
Other
Project Description
Area to be Altered (sq meters / acres)
Proposed Timeline (Start - End Dates)
Environmental Impact & Mitigation Measures
Supporting Documents (list or description)
Applicant Signature
Date