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EPD- Construction Land Disturbance Application
View Application
Permit Number
Project Information
Permit Number
Project Name
Location/Property Address
Primary Permittee Name
Permittee Address
24- Hr. Contact #
Email
Acres Disturbed in an area with a local issuing authority:
Acres Disturbed in an area with no local issuing authority:
Acres Disturbed by an entity exempt from local issuing Authority regulation pursuant to statue:
Total fee submitted
Printed Name
Title
I Agree that all information above is accurate and true.
Submit
