Protection of Waters: Instructions for Joint Application for Permit (FORM 95 19 3)
| Item # | description | instruction |
|---|---|---|
| Item 1 | Permits Sought. | Indicate all the permits applied for. Project review will be concurrent for all permits requested. |
| Item 2 | Previous Permits, Applications. |
List all permits or applications (from DEC or other governmental agency), with numbers and dates of each, which have been issued previously for this project or for another project at this location. |
| Item 3 | Taxpayer IDS. | Any applicant except a private individual must enter their taxpayer identification number. |
| Item 4 | Applicant. | Check the applicable boxes. |
| Item 5 | Applicant Name and Address. | Use the name of the individual, corporation, municipality, or agency legally responsible for the project or activity. For example: for a municipality, use "Town of Wheeler" not "Mayor James Smith;" for a company, use "Smith Estates Corporation" not "Jim Smith;" for an individual, use "James Smith." |
| Item 6 | Name and Address of Owner or Agent/Contact Person. |
Enter the name and address of the person DEC should contact about the project. This may be a town official, a consultant, an engineer or the owner of the property itself. Enter this information only if it is different from the information in Item 5. |
| Item 7 | Project/Facility Location. |
Fill in the named boxes for County, Town/City/Village and Tax Map Number. For address boxes, use mailing address or use other descriptive information which pinpoints the project (i.e., number of nearest utility pole or highway marker, distance to nearest intersection, geographic location of the project on a specific body of water). |
| Items 8-14 | Enter the required information. | |
| Item 15 | Project Description |
Give a brief description of the proposed project, including a reasonable estimate of quantities of material to be excavated or placed, all pertinent dimensions of the project to be built and the location of the project with respect to the protected watercourse or body of water. More detail should be given in the accompanying maps and plans. Describe the purpose for which this project is being undertaken. |
| Item 16 | Other Permits. | Indicate any other permits required by other agencies which are needed for this project. Also indicate any other permits, which are the responsibility of another applicant and are needed for the project which involves this application. (For example: list a Water Supply Application applied for by a town to serve the same subdivision project as this Protection of Waters application applied for by the landowner/developer.) |
The application must be Signed and Dated by the applicant, and also by the agent/contact person if applicable, or it cannot be processed.
Application for Permit for the Construction, Reconstruction or Repair of a Dam or Other Impoundment Structure; Supplement D-1 (FORM 93-19-2)
Use Supplement D-1 in addition to the Joint Application for Permit if your project involves a dam or other impoundment.
Instructions are on the back of the form (the second page when downloaded from our web site).
A Professional Engineer must design and supervise the work and you must include their Professional Engineer License Number in Items 19 and 20.
The application must be Signed and Dated or it cannot be processed.
Application for Permit for the Construction, Reconstruction or Expansion of Docking and Mooring Facilities (Including Platforms and Breakwaters); Supplement D-2 (FORM 95-19-007)
Use Supplement D-2 in addition to the Joint Application for Permit if your project involves a docking or mooring facility.
Instructions are on the back of the form. (the second page when downloaded from our web site) Definitions listed on the back of the form will be helpful to you.
The application must be Signed and Dated or it cannot be processed.
