WETLANDS PERMIT APPLICATION (SECTION 404)

PART I: APPLICANT INFORMATION

A. Applicant

Applicant Name: [________________________________]
Applicant Type: ☐ Individual ☐ Corporation ☐ Partnership ☐ Government ☐ Other

Mailing Address:
Street: [________________________________]
City: [________________________________]
State: [____] ZIP Code: [__________]

Phone: [________________________________]
Email: [________________________________]

B. Authorized Agent (if applicable)

Agent Name: [________________________________]
Company: [________________________________]
Address: [________________________________]
City: [________________________________] State: [____] ZIP: [__________]
Phone: [________________________________]
Email: [________________________________]

Agent Authorization Attached: ☐ Yes ☐ No (required if agent submits on behalf of applicant)

C. Property Owner (if different from applicant)

Owner Name: [________________________________]
Address: [________________________________]
City: [________________________________] State: [____] ZIP: [__________]
Phone: [________________________________]

Owner Authorization Attached: ☐ Yes ☐ No (required if applicant is not owner)

PART II: PROJECT LOCATION

A. Site Address

Street Address: [________________________________]
City: [________________________________]
County: [________________________________]
State: [________________________________]
ZIP Code: [__________]

B. Geographic Coordinates

Project Centroid:
Latitude: [____° ____' ____" N] or [____.__________°]
Longitude: [____° ____' ____" W] or [____.__________°]

Datum Used: ☐ NAD83 ☐ WGS84 ☐ Other: [________]

C. Legal Description

Section: [____] Township: [____] Range: [____]
Parcel Number(s): [________________________________]

Detailed Legal Description:
[________________________________]
[________________________________]
[________________________________]

D. Directions to Site

[________________________________]
[________________________________]
[________________________________]

E. Corps of Engineers District

District: [________________________________]
Regulatory Office: [________________________________]

PART III: PROJECT DESCRIPTION

A. Project Purpose and Need

Project Purpose:
[________________________________]
[________________________________]
[________________________________]

Project Need:
[________________________________]
[________________________________]
[________________________________]

B. Project Type

Activity Category:
☐ Residential Development
☐ Commercial Development
☐ Industrial Development
☐ Transportation/Infrastructure
☐ Mining/Extraction
☐ Agricultural
☐ Recreation
☐ Environmental Restoration
☐ Utility Installation
☐ Other: [________________________________]

C. Detailed Project Description

Description of Work:
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]

Construction Methods:
[________________________________]
[________________________________]

Construction Schedule:
Start Date: [__/__/____]
Completion Date: [__/__/____]

D. Materials to be Discharged

Fill Material Type:
☐ Clean Fill (soil, sand, gravel, rock)
☐ Concrete/Riprap
☐ Pilings
☐ Other: [________________________________]

Volume of Fill:
Cubic Yards: [________________]
Square Feet of Impact: [________________]

Source of Fill Material:
[________________________________]

PART IV: WATERS AND WETLANDS INFORMATION

A. Waters of the United States Affected

Type of Waters:
☐ Wetlands (emergent, scrub-shrub, forested)
☐ Rivers/Streams (perennial, intermittent, ephemeral)
☐ Lakes/Ponds
☐ Tidal Waters
☐ Other Special Aquatic Sites
☐ Other Waters: [________________________________]

B. Wetland Delineation

Delineation Performed: ☐ Yes ☐ No
Delineation Date: [__/__/____]
Delineated By: [________________________________]
Qualifications: [________________________________]

Delineation Methodology:
☐ 1987 Corps of Engineers Wetland Delineation Manual
☐ Regional Supplement Applied: [________________________________]

Total Wetland Area on Site: [________________] acres

Approved Jurisdictional Determination (AJD):
☐ Requested ☐ Obtained (Date: [__/__/____], File #: [________________])
☐ Preliminary JD Accepted ☐ Not Requested

C. Wetland Characterization

Wetland Functions and Values:
☐ Flood Storage/Flood Attenuation
☐ Groundwater Recharge/Discharge
☐ Sediment/Toxicant Retention
☐ Nutrient Removal/Transformation
☐ Wildlife Habitat
☐ Fish Habitat
☐ Uniqueness/Heritage
☐ Recreation
☐ Other: [________________________________]

D. Stream Characterization (if applicable)

PART V: PERMIT TYPE REQUESTED

A. Type of Authorization Requested

☐ Nationwide Permit (NWP)
NWP Number(s): [________________________________]
☐ Pre-Construction Notification (PCN) Required

☐ Regional General Permit (RGP)
RGP Number: [________________________________]

☐ Individual Permit (Standard)

☐ Letter of Permission (LOP)

B. Nationwide Permit Eligibility (if applicable)

2026 NWP being requested: [________________________________]

NWP Conditions Review:
☐ All general conditions can be met
☐ All regional conditions can be met
☐ All NWP-specific conditions can be met

Thresholds Check:
☐ Wetland loss does not exceed 0.5 acres (or applicable threshold)
☐ Stream loss does not exceed 300 linear feet (or applicable threshold)
☐ Combined loss does not exceed 0.5 acres (or applicable threshold)

PART VI: ALTERNATIVES ANALYSIS

A. Avoidance

Steps Taken to Avoid Impacts:
[________________________________]
[________________________________]
[________________________________]

Practicable Alternatives Considered:

B. Minimization

Steps Taken to Minimize Impacts:
[________________________________]
[________________________________]
[________________________________]

Impact Minimization Measures:
☐ Reduced project footprint
☐ Use of elevated structures
☐ Use of pervious materials
☐ Erosion and sediment controls
☐ Construction timing restrictions
☐ Buffer zones established
☐ Other: [________________________________]

C. Compensation (Mitigation)

Mitigation Required: ☐ Yes ☐ No

If Yes, Mitigation Type:
☐ Mitigation Bank Credits
- Bank Name: [________________________________]
- Service Area: [________________________________]
- Credits Required: [________________]

☐ In-Lieu Fee Program
- Program Name: [________________________________]
- Amount: $[________________]

☐ Permittee-Responsible Mitigation
- Type: ☐ Restoration ☐ Enhancement ☐ Establishment ☐ Preservation
- Location: [________________________________]
- Acreage: [________________]

Mitigation Ratio: [____:1]

PART VII: IMPACT SUMMARY

A. Permanent Impacts

B. Temporary Impacts

C. Secondary and Cumulative Impacts

Secondary Impacts:
[________________________________]
[________________________________]

Cumulative Impacts:
[________________________________]
[________________________________]

PART VIII: ENVIRONMENTAL INFORMATION

A. Endangered Species Act

Listed Species/Critical Habitat in Project Area:
☐ No listed species or critical habitat present
☐ Listed species may be present: [________________________________]
☐ Critical habitat designated: [________________________________]

ESA Consultation Status:
☐ No effect determination appropriate
☐ May affect, not likely to adversely affect - informal consultation
☐ May affect, likely to adversely affect - formal consultation required
☐ Biological Assessment attached

B. National Historic Preservation Act

Cultural Resources Survey Conducted: ☐ Yes ☐ No
Survey Date: [__/__/____]
Conducted By: [________________________________]

Historic Properties in Area of Potential Effects:
☐ No historic properties present
☐ Historic properties present: [________________________________]

Section 106 Consultation Status:
☐ No historic properties affected
☐ No adverse effect
☐ Adverse effect - MOA required

C. Other Environmental Considerations

Essential Fish Habitat (EFH):
☐ Not applicable (no EFH present)
☐ EFH present - assessment attached
☐ EFH consultation completed

Coastal Zone Management:
☐ Not applicable (not in coastal zone)
☐ Coastal zone consistency determination required
☐ State concurrence obtained/pending

Wild and Scenic Rivers:
☐ Not applicable
☐ Project within designated river corridor

PART IX: STATE CERTIFICATION

A. Section 401 Water Quality Certification

State Certifying Agency: [________________________________]

Certification Status:
☐ Application submitted (Date: [__/__/____])
☐ Certification obtained (Date: [__/__/____])
☐ Certification waived
☐ Certification pending

Certification Number: [________________________________]

Special Conditions: [________________________________]

B. State Wetland Permit (if required separately)

State Permit Required: ☐ Yes ☐ No

If Yes:
State Agency: [________________________________]
Application Submitted: [__/__/____]
Permit Status: ☐ Pending ☐ Issued ☐ Denied

PART X: REQUIRED ATTACHMENTS

Application Materials Checklist

☐ ENG Form 4345 (Application for Department of the Army Permit)
☐ Vicinity Map (USGS quad or equivalent, 1:24,000 scale)
☐ Site Plan/Project Plans showing:
- Property boundaries
- Wetland boundaries
- Project footprint
- Impact areas
- Mitigation areas (if applicable)
☐ Cross-Sections (typical and through impact areas)
☐ Wetland Delineation Report (if not previously approved)
☐ Jurisdictional Determination Request (if needed)
☐ Alternatives Analysis
☐ Mitigation Plan (if required)
☐ Endangered Species Information
☐ Cultural Resources Survey (if conducted)
☐ 401 Water Quality Certification (or application)
☐ Adjacent Property Owner List (within distance specified by District)
☐ Agent Authorization Letter (if applicable)
☐ Property Owner Authorization (if applicant is not owner)
☐ Application Fee ($[________])

PART XI: CERTIFICATION

Applicant Certification

I hereby certify that the information in this application is complete and accurate. I am aware that submission of false, incomplete, or misleading information is a violation of federal law. I understand that a permit, if issued, does not convey any property rights, nor authorize any injury to the property or rights of others. I agree to allow representatives of the U.S. Army Corps of Engineers, upon proper identification, to enter upon the property that is the subject of this application to inspect the site and verify the information submitted.

Applicant Signature: [________________________________]
Printed Name: [________________________________]
Date: [__/__/____]

Agent Certification (if applicable)

I hereby certify that I am authorized to act as agent for the applicant in this matter.

Agent Signature: [________________________________]
Printed Name: [________________________________]
Date: [__/__/____]

STATE-SPECIFIC NOTES

California

• California Coastal Commission has jurisdiction in coastal zone
• Regional Water Quality Control Boards issue 401 certifications
• California Department of Fish and Wildlife requires Streambed Alteration Agreement (Section 1602)
• San Francisco Bay Conservation and Development Commission has jurisdiction in SF Bay
• Additional CEQA review may be required

Texas

• TCEQ issues 401 certifications
• Texas Parks and Wildlife may require coordination for endangered species
• Texas General Land Office has jurisdiction over state-owned submerged lands
• Railroad Commission of Texas for certain activities in coastal waters
• No state wetland permit program

Florida

• FDEP issues Environmental Resource Permits (ERP) with wetland permitting authority
• Water Management Districts have delegated ERP authority in most areas
• State 401 certification combined with ERP in most cases
• Florida Fish and Wildlife Conservation Commission coordination for listed species
• Sovereign submerged lands lease may be required

New York

• NYSDEC administers state freshwater wetlands program (ECL Article 24)
• Tidal wetlands regulated separately (ECL Article 25)
• 401 certification issued by NYSDEC
• Additional State Pollutant Discharge Elimination System (SPDES) permits may be required
• Adirondack Park Agency has jurisdiction within Adirondack Park

SOURCES AND REFERENCES

• Army Corps of Engineers Permit Program: https://www.usace.army.mil/Missions/Civil-Works/Regulatory-Program-and-Permits/
• EPA Section 404 Program: https://www.epa.gov/cwa-404
• 2026 Nationwide Permits: Federal Register (January 2026)
• 33 CFR Parts 320-332 (Corps Regulations)
• 40 CFR Part 230 (404(b)(1) Guidelines)

This template is provided for general informational purposes. Wetlands permit applications are complex and require coordination with multiple agencies. Always consult with qualified wetland scientists, environmental consultants, and legal counsel before submitting any permit application.