CASE # ________________________ RECEIVED

WARREN TOWNSHIP PLANNING BOARD

APPLICATION FOR WATERCOURSE PROTECTION AREA

SITE NAME:

APPLICATION is hereby made for ____________________________in a watercourse protection area.

DESCRIBE PROPOSED ENCROACHMENT

1. Applicant’s Name ______________________________Phone ____________Fax:______________

Address ________________________________________________________________________

2. Owner’s Name ________________________________Phone_____________Fax: _____________

Address ________________________________________________________________________

3. Attorney’s Name _______________________________Phone_____________Fax:_____________

Firm and Address _________________________________________________________________

4. Name and Address of Person Preparing Plans _______Phone _____________Fax:_____________

PROFESSION

5. Location of Subdivision ____________________________________________________________

STREET

_______________________________________________________________________________

TAX MAP BLOCK LOT(S) TOTAL AREA OF ACREAGE

6. Number of proposed Lots __________________________________________________________

7. List any zoning variances required and if so, in addition, attach hereto as a separate rider your

factual basis and legal theory for the relief sought.

_______________________________________________________________________________

_______________________________________________________________________________

8. Deed restrictions that apply or are contemplated. (If no restrictions, state “NONE”, if ‘YES”

attach copy.

_______________________________________________________________________________

9. Development Plans _______________________________________________________________

a. Sell lots only? (yes or no) _________Construction of homes for sale? (yes or no) ____________

b. Other _______________________________________________________________________

Revised: 1-1-93; Rev. 7-16-97; 6/3/2010

WARREN TOWNSHIP PLANNING BOARD

WATERCOURSE PROTECTION AREA APPLICATION

PAGE TWO

10. Briefly describe any prior or presently pending proceedings before the Warren Township

Planning Board or any other federal, state, or local board or agency involving the

property which is the subject of this application.

11. List any other material accompanying this application, i.e. plans, drainage, calculations, etc.

_______________________________________________________________________________

_______________________________________________________________________________

___________________________________

Applicant’s Signature Date

CONSENT OF OWNER IF OTHER THAN APPLICANT

I, THE UNDERSIGNED, BEING THE OWNER OF THE LOT OR TRACT DESCRIBED IN THE FOREGOING APPLICATION, HEREBY CONSENT TO THE MAKING OF THIS APPLICATION AND THE APPROVAL OF THE PLANS SUBMITTED HEREWITH.

DATE: ____________________________ ___________________________________

Owner’s Signature Date

WITNESS: _________________________ ___________________________________

Owner’s Signature Date

___________________________________

Owner’s Signature Date

Revised: 1-1-93; Rev. 7-16-97; 6/3/2010