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2. Requestor's Information
4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Email*
16. Phone1*
20. Signature of Property Owner, or designated legal agent, granting permission for Town Staff to enter the property(ies) for the purpose of performing the Stream Determination.
22. Owner Name(s)/Agent Name*
23. Electronic Signature*

    1. By checking this box you are verifying this as your electronic signature.
25. Date and Time*
    Date and Time

    Date and Time
26. I am *

    1. The Property Owner
    2. The Authorized agent
28. Company Name (if applicable)
30. Attach the "Authorized Agent for Legal Representation Form"

    If you are not the property owner then this form is required before staff will accept the request. 

31. Authorized Agent for Legal Representation Form
    Authorized Agent for Legal Representation Form

    Please note that wet signatures are required.

35. Property Information

    Fill in Parcel ID Number  (PIN) and address. Submit a Seperate Form for multiple PINs.

37. Parcel ID Number (PIN)*
39. Address1*
41. Address2
43. City*
44. State*
45. Zip*
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit Submit and Print

* indicates a required field