WETLANDS IMPACT EVALUATION



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Submittal Date: Sequence No.: District: Requesting Agency:  
1. Does the project have wetland impacts? Type:
 

2. Identify each wetland site being affected and acreage from each expected to be converted to other use(s).

Wetland Impacts and Mitigation Required

Site No.
Type
T&E
Nature Preserve
Natural Area
Essential Habitat
Size(acres)
Acres of Impact
 
 
3. Briefly describe the measures considered to avoid and minimize adverse impacts to the wetlands:
 
4. Summarize briefly why there are no practicable alternatives to the use of the wetland(s):
 
5. Mitigation site:  
 
6. Mitigation basin:  
 
7. Local Contact Person: Telephone #: ( ) - ext.
Title: E-Mail:
Company:
 
8. Additional Information:Memo By: Submitted By: