Riparian Buffer Determination Request Form (Print Only)
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10 Johnston County Public Utilities 309 E Market Street PO Box 2263 Smithfield , NC 27577 919 209 - 8333 • Prior to the Buffer Determination call , fees must be paid 500 1 - 2 calls on the site , 125 each additional call • Prior to completing a Buffer Determination Request Form , a wetlands delineation should be completed at theproject site • Provide a map of all wetlands on the parcel s • Provide a copy of any previous buffer determinations on the property BUFFER DETERMINATION REQUEST FORM Date Received JCPU Use Only Project # Property Owner Information Name s on Recorded Deed Responsible Party for LLC if different from owner Mailing Address Telephone Number Email Address Parcel Tax ID Address of Property Project Description attach plan if available Consu ltant Agent Information Name , Company Mailing Address Telephone Number Email Address Name of Project County Nearest Named S tream River Basin Has anyone from DWR visited the site Yes No Staff Name Date of Visit • Attach a map of the site indicating project boundaries on the USGS 1 24,000 Topo and or NRCS Soil Survey • Provide approval from property owner for us to enter the property if the developer and property owner are notthe same Please return form to Johnston County Public Utilities 309 E Market Street PO Box 2263 Smithfield , NC 27577 charlespender @ johnstonnccomPage