Critical Area Report Worksheet To Accompany The Site Plan Form
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1CRITICAL AREA REPORT WORKSHEET TO ACCOMPANY THE SITE PLAN
Permit Number _________________________________________
Total Site Area ___________________ Square Feet (1 Acre = 43,560 Square Feet)
Total Wooded Area ___________________ Square Feet- ‘Wooded’ MEANS A BIOLOGICAL
COMMUNITY DOMINATED BY TREES AND OTHER WOODY PLANTS (SHRUBS AND
UNDERGROWTH), INCLUDING FORESTS THAT HAVE BEEN CUT BUT NOT CLEARED.
∗ Please Indicate Square Footage of Woodland Removed for the following:
1. House ___________________ Sq. Ft.
5. Accessory Structure __________________ Sq. Ft.
2. Septic or sewer ____________ Sq. Ft.
6. Additions __________________________ Sq. Ft.
3. Well ____________________ Sq. Ft.
7. Storm Water Management _____________ Sq. Ft.
4. Driveway ________________ Sq. Ft.
8. Other Clearing: work area; access; stockpiles,
etc. ___________________________ Sq. Ft.
∗ Total Woodland Removed = ___________________ Sq. Ft.
“Impervious Coverage” IS ANY SURFACE THAT WILL NOT ABSORB LIQUID. THIS INCLUDES
ROOFS, SIDEWALKS, DRIVEWAYS, AND ANY TYPE OF PAVEMENT. COMPACTED
GRAVAEL IS CONSIDERED AN IMPERVIOUS SURFACE.
∗ Please Indicate Square Footage of Impervious Coverage for the following:
Existing Impervious
Proposed Impervious
1. House (roof area) ________________ Sq. Ft.
1. House (roof area) ___________________ Sq. Ft.
2. Driveway + Sidewalks ____________ Sq. Ft.
2. Driveway + Sidewalks _______________ Sq. Ft.
3. Accessory Structures ______________ Sq. Ft.
3. Accessory Structures ________________ Sq. Ft.
4. Additions __________________________ Sq. Ft.
∗ Total Existing and Proposed Impervious Coverage __________________ Sq. Ft.
⊛
PLEASE INCLUDE ALL EXISTING AND PROPOSED SQUARE FOOTAGE.
I _________________________, ______________________, (property owner and contract purchaser, if
applicable) hereby certify that the above critical area worksheet is true and correct based upon personal
knowledge. I further declare that a copy of the foregoing document will be transferred to any purchaser of
this property from me (or corporation, if applicable) at the time of settlement. I hereby understand that
these computations shall be a binding part of issuance of a building permit for lot # _______, block #
_______ of Subdivision _____________________________.
I hereby certify that I have seen and read the record plat (if approved after 1986 and subject to Critical
Area requirements) and have indicated on the attached site plan any easements, buffers, or other
restrictions declared on said plat.
_____________________________________ (Signature) ____________________ (Date)
_____________________________________ (Title)
_____________________________________ (Signature) ____________________ (Date)
_____________________________________ (Title)
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