Natural Heritage Data Request Form - State Of New Jersey printable pdf download

State of New Jersey

Mail Code 501-04

Department of Environmental Protection

Natural Heritage Data Request Form

The New Jersey Natural Heritage Program

DEP-Office of Natural Lands Management

P.O. Box 420, Trenton, New Jersey 08625-0420

(609) 984-1339

Fax No.: (609) 984-1427

PLEASE PRINT AND SUBMIT COMPLETED FORM WITH ATTACHMENTS TO THE ADDRESS ABOVE

(Fields shown in bold font must be completed in order for data request to be processed.)

Name:

Agency/Company:

Address:

City:

State:

Zip:

Daytime Phone:

Ext.:

Cell Phone:

Email:

Project Name:

Municipality(ies):

County(ies):

Block(s):

Lot(s):

N.A.D. 1983 State Plane Coordinates (feet) 6 digits only:

E (x):

N (y):

Project Description: ______________________________________________________________________________________

______________________________________________________________________________________

USGS Quad:

___ A copy of a USGS quad map(s) that clearly indicates the site boundary is included with this

form. Specify name of USGS quad(s): _____________________________________

(USGS quad maps are required, unless prior arrangements have been made to submit site boundaries in an

alternate format. Responses will be delayed if site locations are not delineated in a suitable format.)

Flood Hazard

Is this request submitted as part of a Flood Hazard Area Control Act rule (N.J.A.C. 7:13)

Control Act Use:

application? Yes____ No ____

Acknowledgement

Any material supplied by the Office of Natural Lands Management will not be published without

& Signature:

crediting the Natural Heritage Database as the source of the material. It is understood that there

will be a charge of $70.00 per hour for the services requested. An invoice will be sent with the

request response and payment should be made by check or money order payable to "Office of

Natural Lands Management."

Signed

Date

_____________________________________________

__________________

Time Frame for Response:

Data requests are processed in the order in which they are received; please allow 30 days for response. If you would like

Natlands@dep.nj.gov

to send in your data request via email, you may do so by sending it to

Due to the number

of attachments, we cannot fax results. Unless you specifically request that your response be mailed or the response is

unusually large, your response will be emailed to the address you provide.

FOR OFFICE USE ONLY

DATE RECEIVED______________________________

Item Code: REG _____ ST _____ RTC _____ NC _____ REGEO _____ STEO _____ RTCEO _____ NCEO _____

Hrs: _____________

Project Code: ____________________________ Inv. #: __________ _____

Natural Heritage Data Request Form - State Of New Jersey

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