Design Review and Preservation Application Application

PROPERTY ADDRESS:__________________________________________________

DATE:_________________

SIGNATURES:
I certify that the above information and plans submitted are true and correct, and that, if required, an application for the Inland/Wetlands permit has been filed before or on the same day as the filing of this application with the P&Z Commission.

_____________________________________________
Signature of Applicant (Required)

I certify that the above information and plans submitted are true and correct, and that, if required, an application for the Inland/Wetlands permit has been filed before or on the same day as the filing of this application with the P&Z Commission.

_____________________________________________
Signature of Agent (if applicable)

I certify that the above information and plans submitted are true and correct, and that, if required, an application for the Inland/Wetlands permit has been filed before or on the same day as the filing of this application with the P&Z Commission.

____________________________________________
Signature of Owner (Required)
______________________________________________________________________________________
To be Filled out by Dept. of Planning, Conservation and Development:

Project#________________________

Date ________________________

Fee ________________________
(if applicable)

________________________
Date of Review/Approval

________________________
Signature of DRPB Staff

( ) Permit Required
( ) Permit Not Required
( ) IWA Review Required
________________________
Signature of IWA Staff

________________________
Date of Review/Approval

________________________
Signature of ZEO