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 of the responsible party or parties. If the responsible party is an agency, company,
corporation or other organization, indicate the 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 (i.e., 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 here.
Block 15. Location of Proposed Project. Enter the county and state 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 Section, Township and Range of
the site and/or the latitude and
longitude. 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 down
from the Highway 14 bridge). If a large river or stream, include the river mile of the proposed project site if known.
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.
Block 18. Nature of Activity. Describe the overall activity or project. Give appropriate dimensions of structures such as
wingwalls, 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.