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Coastal Applicability Determination Checklist Template - New Jersey Department Of Environmental Protection

State of New Jersey

Department of Environmental Protection

COASTAL APPLICABILITY DETERMINATION CHECKLIST

Revised: August, 2015

Website:

CALL NJDEP AT (609) 777-0454 IF YOU HAVE ANY QUESTIONS

This checklist applies to applicability determinations under CAFRA, the Waterfront Development Law, and

Wetlands Act of 1970. Please complete this form and submit it along with the below information to:

Regular mail

For hand delivery, courier service and overnight mail

NJ Department of Environmental Protection

Division of Land Use Regulation

P.O. Box 420, Code 501-02A

501 East State Street

Trenton, New Jersey 08625-

Station Plaza 5, Second Floor

Attn: Application Support

Trenton, New Jersey, 08609

Attn: Application Support

Complete the following:

Applicant Name:

__________________________________________________________

Address:

__________________________________________________________

City: __________________ State: _____________Zip:

___________

Agent:

__________________________________________________________

Address:

__________________________________________________________

City: __________________ State: _____________Zip:

___________

Daytime Phone #:

______________________ E:Mail: _____________________________

Project Location:

Block(s); _______________ Lot(s)

_____________________________

County: ________________ Municipality: _________________________

Site Address: _______________________________________________

(or nearest crossroads)

2. Submit the following information along with a completed copy of this form:

A. A written description of the:

Site and the proposed development including the dimensions, number, and uses of any proposed structures;

ii.

Length of any proposed linear development; and

iii. Number of any parking spaces proposed;

A copy of the site plan and/or survey for the proposed project; and

C. A copy of a USGS quad map or local street map with the project site clearly indicated.

D. Color Photos of the site with photo location.

OFFICIAL USE ONLY - NJEMS Pre-Review Form

PI #: ________________________________________

Activity #: _____________________________________

Coastal Applicability Determination Checklist Template - New Jersey Department Of Environmental Protection

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