Application for Department of the Army Permit

Instructions for Preparing a
Department of the Army Permit Application
Blocks 1 through 4. To be completed by Corps of Engineers.
Block 5. Applicant’s Name. Enter the name and the E-mail address of the responsible party or parties. If the
responsible party is an agency, company, corporation, or other organization, indicate the name of the organization
and responsible officer and title. If more than one party is associated with the application, please attach a sheet with
the necessary information marked Block 5.
Block 6. Address of Applicant. Please provide the full address of the party or parties responsible for the application.
If more space is needed, attach an extra sheet of paper marked Block 6.
Block 7. Applicant Telephone Number(s). Please provide the number where you can usually be reached during
normal business hours.
Blocks 8 through 11. To be completed, if you choose to have an agent.
Block 8. Authorized Agent’s Name and Title. Indicate name of individual or agency, designated by you, to
represent you in this process. An agent can be an attorney, builder, contractor, engineer, or any other person or
organization. Note: An agent is not required.
Blocks 9 and 10. Agent’s Address and Telephone Number. Please provide the complete mailing address of the
agent, along with the telephone number where he / she can be reached during normal business hours.
Block 11. Statement of Authorization. To be completed by applicant, if an agent is to be employed.
Block 12. Proposed Project Name or Title. Please provide name identifying the proposed project, e.g., Landmark
Plaza, Burned Hills Subdivision, or Edsall Commercial Center.
Block 13. Name of Waterbody. Please provide the name of any stream, lake, marsh, or other waterway to be
directly impacted by the activity. If it is a minor (no name) stream, identify the waterbody the minor stream enters.
Block 14. Proposed Project Street Address. If the proposed project is located at a site having a street address (not
a box number), please enter it here.
Block 15. Location of Proposed Project. Enter the latitude and longitude of where the proposed project is located.
If more space is required, please attach a sheet with the necessary information marked Block 15.
Block 16. Other Location Descriptions. If available, provide the Tax Parcel Identification number of the site,
Section, Township, and Range of the site (if known), and / or local Municipality that the site is located in.
Block 17. Directions to the Site. Provide directions to the site from a known location or landmark. Include highway
and street numbers as well as names. Also provide distances from known locations and any other information that
would assist in locating the site. You may also provide description of the proposed project location, such as lot
numbers, tract numbers, or you may choose to locate the proposed project site from a known point (such as the right
descending bank of Smith Creek, one mile downstream from the Highway 14 bridge). If a large river or stream,
include the river mile of the proposed project site if known
Block 18. Nature of Activity. Describe the overall activity or project. Give appropriate dimensions of structures such
as wing walls, dikes (identify the materials to be used in construction, as well as the methods by which the work is to
be done), or excavations (length, width, and height). Indicate whether discharge of dredged or fill material is involved.
Also, identify any structure to be constructed on a fill, piles, or float-supported platforms.
The written descriptions and illustrations are an important part of the application. Please describe, in detail, what you
wish to do. If more space is needed, attach an extra sheet of paper marked Block 18.
Block 19. Proposed Project Purpose. Describe the purpose and need for the proposed project. What will it be used
for and why? Also include a brief description of any related activities to be developed as the result of the proposed
project. Give the approximate dates you plan to both begin and complete all work.

Block 20. Reasons for Discharge. If the activity involves the discharge of dredged and/or fill material into a wetland
or other waterbody, including the temporary placement of material, explain the specific purpose of the placement of
the material (such as erosion control).
Block 21. Types of Material Being Discharged and the Amount of Each Type in Cubic Yards. Describe the
material to be discharged and amount of each material to be discharged within Corps jurisdiction. Please be sure this
description will agree with your illustrations. Discharge material includes: rock, sand, clay, concrete, etc.
Block 22. Surface Areas of Wetlands or Other Waters Filled. Describe the area to be filled at each location.
Specifically identify the surface areas, or part thereof, to be filled. Also include the means by which the discharge is to
be done (backhoe, dragline, etc.). If dredged material is to be discharged on an upland site, identify the site and the
steps to be taken (if necessary) to prevent runoff from the dredged material back into a waterbody. If more space is
needed, attach an extra sheet of paper marked Block 22.
Block 23. Description of Avoidance, Minimization, and Compensation. Provide a brief explanation describing
how impacts to waters of the United States are being avoided and minimized on the project site. Also provide a brief
description of how impacts to waters of the United States will be compensated for, or a brief statement explaining why
compensatory mitigation should not be required for those impacts.
Block 24. Is Any Portion of the Work Already Complete? Provide any background on any part of the proposed
project already completed. Describe the area already developed, structures completed, any dredged or fill material
already discharged, the type of material, volume in cubic yards, acres filled, if a wetland or other waterbody (in acres
or square feet). If the work was done under an existing Corps permit, identity the authorization, if possible.
Block 25. Names and Addresses of Adjoining Property Owners, Lessees, etc., Whose Property Adjoins the
Project Site. List complete names and full mailing addresses of the adjacent property owners (public and private)
lessees, etc., whose property adjoins the waterbody or aquatic site where the work is being proposed so that they
may be notified of the proposed activity (usually by public notice). If more space is needed, attach an extra sheet of
paper marked Block 24.
Information regarding adjacent landowners is usually available through the office of the tax assessor in the
county or counties where the project is to be developed.
Block 26. Information about Approvals or Denials by Other Agencies. You may need the approval of other
federal, state, or local agencies for your project. Identify any applications you have submitted and the status, if any
(approved or denied) of each application. You need not have obtained all other permits before applying for a Corps
permit.
Block 27. Signature of Applicant or Agent. The application must be signed by the owner or other authorized party
(agent). This signature shall be an affirmation that the party applying for the permit possesses the requisite property
rights to undertake the activity applied for (including compliance with special conditions, mitigation, etc.).

DRAWINGS AND ILLUSTRATIONS
General Information.
Three types of illustrations are needed to properly depict the work to be undertaken. These illustrations or drawings
are identified as a Vicinity Map, a Plan View or a Typical Cross-Section Map. Identify each illustration with a figure or
attachment number.
Please submit one original, or good quality copy, of all drawings on 8½ x11 inch plain white paper (electronic media
may be substituted). Use the fewest number of sheets necessary for your drawings or illustrations.
Each illustration should identify the project, the applicant, and the type of illustration (vicinity map, plan view, or crosssection). While illustrations need not be professional (many small, private project illustrations are prepared
by hand), they should be clear, accurate, and contain all necessary information.