Name:
Email:
Phone:
Customer Type: Land Developer/ConsultantPrivate LandownerAgriculturalOther
State where impact occurs: AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
County where impact occurs:
Section/Township/Range where impact occurs (if known):
8 Digit HUC (if known):
Size of Impact:
Square FeetAcres
# of Credits Required by Regulatory after ratio adjustment:
Wetland Type Impacted (if known): —Please choose an option—1 - Seasonally Flooded Basin or Floodplains2 - Wet Meadow3 - Shallow Marsh4 - Deep Marsh5 - Shallow Open Water6 - Shrub Swamp7 - Wooded Swamp8 - BogsU - Upland BufferEstuarineNon-RiparianPalustrine EmergentPalustrine ForestedRiparianRiparian, Non-RiverineRiverineStreamTidal FringeMultiple Types/Other (Indicate in Remarks Section)
Agencies you are working with (check all that apply): US Army Corps of EngLocal Gov. UnitNRCSNoneOther Any Additional Information Including Specific Location Info and a Short Description of the Project:
