APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT
OMB APPROVAL NO. 0710-0003
(33 CFR 325)
Expires December 31, 2004
The Public burden for this collection of information is estimated to average 10 hours per response, although the majority of applications should
require 5 hours or less. This includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Service Directorate of Information
Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302; and to the Office of Management and Budget,
Paperwork Reduction Project (0710-0003), Washington, DC 20503. Respondents should be aware that notwithstanding any other provision of law,
no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control
number. Please DO NOT RETURN your form to either of those addresses. Completed applications must be submitted to the District Engineer having
jurisdiction over the location of the proposed activity.
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection , Research and
Sanctuaries Act, Section 103, 33 USC 1413. Principal Purpose: Information provided on this form will be used in evaluating the application for a
permit. Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local government agencies.
Submission of requested information is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit
be issued.
One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this
application (see sample drawings and instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed
activity. An application that is not completed in full will be returned.
(ITEMS 1 THRU 4 TO BE FILLED BY THE CORPS)
1. APPLICATION NO.
2. FIELD OFFICE CODE
3. DATE RECEIVED
4. DATE APPLICATION
COMPLETED
(ITEMS BELOW TO BE FILLED BY APPLICANT)
5. APPLICANT'S NAME
8. AUTHORIZED AGENT'S NAME AND TITLE
(an agent is not required)
6. APPLICANT'S ADDRESS
9. AGENT'S ADDRESS
7. APPLICANT'S PHONE NOS. W/AREA CODE
10. AGENT'S PHONE NOS. W/AREA CODE
a. Residence
a. Residence
b. Business
b. Business
11.
STATEMENT OF AUTHORIZATION
I hereby authorize,
to act in my behalf as my agent in the processing of this application
upon request, supplemental information in support of this permit application.
APPLICANT'S SIGNATURE
DATE
NAME, LOCATION AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE
(see instructions)
13. NAME OF WATERBODY, IF KNOWN
14. PROJECT STREET ADDRESS
(if applicable)
(if applicable)
15. LOCATION OF PROJECT
COUNTY
STATE
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN,
(see instructions)
17. DIRECTIONS TO THE SITE
ENG FORM 4345, Jul 97
EDITION OF FEB 94 IS OBSOLETE.
(Proponent:
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