Shoreline Management Act
Permit Data Sheet and Transmittal Letter
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(local government) |
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To: |
(appropriate Ecology office) |
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| Date of Transmittal: |
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Date of Receipt: |
(provided by Ecology) |
| Type of Permit: (Indicate all that apply) |
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| Substantial Development ; Conditional Use ; Variance ; Revision ; Other . |
| Local Government Decision: Approval ; Conditional Approval ; Denial : |
| Applicant Information: |
Applicant's Representative: (if primary contact) |
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Name: |
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| Address: |
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Address: |
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Phone(s): |
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| Is the applicant the property owner? yes no |
| Location of the Property: (Section Township and Range to the nearest 1/4, 1/4 Section or latitude and longitude,
and a street address where available) |
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| Water Body Name: |
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| Shoreline of Statewide Significance: Yes No . |
| Environment Designation: |
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| Description of the Project: (Summary of the intended use or project purpose) |
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| Notice of Application Date: |
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Final Decision Date: |
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| By: |
(Local Government Primary Contact on this Application) |
| Phone No: |
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