Riparian Buffer Zone Impact Permit
Applicant Information
Name
Organization
Address
Phone
Email
Project Information
Project Title
Project Location (Address or Coordinates)
Project Description
Riparian Buffer Impact Details
Affected Buffer Zone Type
Stream
Wetland
Lake
Total Area of Impact (sq ft or sq m)
Description of Proposed Activity
Purpose and Need for Impact
Mitigation Plan
Describe Proposed Mitigation Measures
Additional Information
Other Relevant Information
Attachments
Document Name
Description
Applicant Signature
Date