Free 37733.pdf - Indiana

APPLICATION FOR BLUE RIVER PERMIT
State form 37733 (R / 3-05)

Pursuant to IC 14-29-7

THE BLUE RIVER COMMISSION P.O. Box 57 New Salisbury, IN 47161

INSTRUCTIONS:

1. Please print or type 2. Return application to the Blue River Commission 2. Telephone #:

1. Name of applicant (owner of property): 3. Address (number and street, city, state, ZIP code)

4. Location and description of applicant's property where project is proposed. (Please attach a map or drawing):

5. Date ownership recorded (month, day, year): 7. Proposed project (please 6. Present use of property: be specific, including distance of project from riverbank. Attach additional sheets if necessary):

8. Signature of Applicant: ____________________________________________________________________

9. Date signed (month, day, year): _______________________________________________

To be completed by Administrator 10. Application for permit number: 12. Comments: 11. Filed (month, day, year):

13. Signature of Administrator: ____________________________________________________________________ 15. Permit issued: YES / NO 17. If denied, reason for denial: 18. Notification of the beginning of the proposed project (month, day, year): 19. Proposed project to begin (month, day, year):

14. Date signed (month, day, year): _______________________________________________

16. Date approved or denied (month, day, year):