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Master Land Use Permit Application Page 2 of 4 CRITICAL AREAS OR BUFFERS ON SITE OR WITHIN 300 FEET: Yes / Type ____________________________ No WATER BODIES WITHIN 200 FEET: Yes / Name:_____________________________ No FLOODPLAIN: Flood Zone: FIRM Panel # Date of Panel: LOT COVERAGE AREA CALCULATIONS: Existing Square Footage: Proposed Square Footage: IMPERVIOUS SURFACE AREA CALCULATIONS: Existing Impervious Square Footage: New Impervious Surface: DESCRIPTION OF SUBJECT PROPOSAL: Additional pages attached PROPOSED WORK: __ _________ _________ _________ _________ _____________________________________________________________________________________________________ _________________________________________________________________________________________________ PROPERTY OWNER INFORMATION: Multiple owners attached NAME: MAILING ADDRESS: CITY, STATE, ZIP: PHONE #: FAX #: EMAIL ADDRESS: APPLICANT INFORMATION: Same as property owner NAME: MAILING ADDRESS: CITY, STATE, ZIP: PHONE #: FAX #: EMAIL ADDRESS: CONTACT PERSON: Same as property owner Same as applicant NAME: MAILING ADDRESS: CITY, STATE, ZIP: PHONE #: FAX #: EMAIL ADDRESS: