Sample Joint Application - Alabama

JOINT APPLICATION AND NOTIFICATION
U. S. DEPARTMENT OF ARMY, CORPS OF ENGINEERS
ALABAMA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
THIS FORM IS TO BE USED FOR PROPOSED ACTIVITIES IN WATERS OF THE UNITED STATES
WITHIN THE POLITICAL BOUNDARIES OF THE STATE OF ALABAMA.
PLEASE TYPE OR PRINT IN INK
1. DATE: ___________ / _______ / ___________
month

day

Application Number:_______________________________

year

(Agency Use Only)

2. APPLICANT INFORMATION:

3. PROJECT LOCATION:
Street Address: ________________________________
City/Community: ______________________________
County: ______________________________________
Name of Waterway: ____________________________
Latitude: _____________________________________
Longitude: ___________________________________

Name: __________________________________________
Company: _______________________________________
Mailing Address: _________________________________
_______________________________________________
_______________________________________________

(Provide Lat/Long in decimal degrees, if available)

Telephone Number and Email (during business hours):
A/C (

Section ______ Township ______ Range ______
County Parcel Identification Number (PID): _________
_____________________________________________

) ____________________________________

Email: __________________________________________

(PID is typically located on property tax receipt)

AGENT INFORMATION:

4. DESIGNATION OF AGENT, STATEMENT OF
AUTHORIZATION:

Name: __________________________________________

N/A  (check here if applicant is not designating an agent)
I hereby designate and authorize

Company: _______________________________________
Mailing Address: _________________________________
_______________________________________________

(Print Name of Designated Agent)

_______________________________________________

to act on my behalf in the processing of this permit application and
to furnish, upon request, supplemental information in support of
the application.

Telephone Number and Email (during business hours):
A/C (

) ____________________________________

Email: __________________________________________
Signature of Applicant

Date

5. PROJECT DESCRIPTION: In addition to required attachments such as drawings/plans, provide a detailed narrative
description of the project. Include all aspects of the project, describing completely and in detail. Provide the dimensions (in feet)
of any structures such as piers, wharfs, bulkheads, pipelines, boathouses, boat ramps, groins, jetties, and appurtenances, as well as
the dimensions (in feet/square feet) and volume (in cubic yards) of any dredging, excavation, or fill activities. Indicate the
method(s) of construction and how the site would be accessed (i.e. by barge or land). Attach additional sheets if necessary.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________

ADEM Form 166 8/19 (ADEM-COE Joint Application)

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6. DREDGING: For projects with dredging, show locations and dimensions of proposed dredge area(s) on attached plans. Include
existing and proposed depths. N/A  (check here if dredging is not proposed)
a. New Work  Maintenance Work 
b. Volume (cubic yards) of material to be removed: ______________________________
c. Type of material (sand, muck, hard bottom, etc.): ______________________________
d. Surface area (square feet) impacted: _______________________________
e. Method of dredging or excavation (hydraulic pump, mechanical, etc.):_________________________________________________
f. Nature of area to be dredged (check all that apply) Upland  Wetland  Waterbottom  Other  (explain): ________
_________________________________________________________________________________________________________
7. DISCHARGE OF DREDGED OR FILL MATERIAL: For projects with discharge of dredged or fill material, show locations and
dimensions of all disposal or fill areas on attached plans. N/A  (check here if discharge of dredged or fill material is not proposed)
a. Volume (cubic yards) of fill: ______________________________
b. Type of fill (sand, clay, rip-rap, etc.): ______________________________
c. Surface area (square feet) impacted: ______________________________
d. Source of fill material (check all that apply): Commercially obtained  Dredged material  Borrowed on-site 
Other  (explain): ________________________________________________________________________________________
e. How will discharge material be contained? Specify containment and/or erosion control measures (i.e. Best Management Practices):
_________________________________________________________________________________________________________
f. Nature of disposal/fill area(s) (check all that apply.) Upland  Wetland  Waterbottom  Other  (explain): _______
_________________________________________________________________________________________________________
8. ADDITIONAL INFORMATION: Provide information below relating to the proposed activity.
a. Are oyster reefs located within or near the project area? Yes  No  If yes, explain: _______________________________
___________________________________________________________________________________________________________
b. Will this project result in the siting, construction, and/or operation of an energy-related facility? Yes  No 
c. Is the project area greater than 5 acres in size? Yes  No 
d. Is any portion of the activity for which authorization is sought now complete? Yes  No  If yes, explain: _____________
___________________________________________________________________________________________________________
_____________________________________ Month and year activity took place: _________________________________________
e. If project is for maintenance work of existing structures or channels, describe legal authorization for the existing work. Provide
permit number, dates, or other form of authorization: ______________________________________________________________
9. PURPOSE AND NEED: Describe the purpose and need of the project. Describe any public benefit, if applicable. Describe the
relationship between the project and any secondary or future development the project is designed to support: ___________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Intended use: Public  Private  Commercial  Other  (explain): ____________________________________________
10. PROJECT SCHEDULE:
Proposed start date: _________________________

Proposed completion date: _________________________

11. ADJACENT PROPERTY OWNER NAMES AND MAILING ADDRESSES: Provide the names and mailing addresses of
adjoining property owners, lessees, etc. whose property adjoins the project. Also, identify the location of each owner’s property on
the plan view drawings. Attach additional sheets as needed.
Owner’s Name: _______________________________________ Owner’s Name: _______________________________________
Mailing Address: ______________________________________ Mailing Address: ______________________________________
____________________________________________________ ____________________________________________________
12. OTHER AUTHORIZATIONS OR CERTIFICATIONS: List all authorizations or certifications requested, received, and/or
required from other federal, state, or local agencies for any structures, construction, discharges, or other activities described in or directly
related to this application. Note: The signature in Section 14 certifies that application has been made to or that permits are not required
from the following agencies. If permits are not required, place “N/A” in space for Type of Approval.
Name of Federal, State, or Local Agency

Type of
Approval

Identification
No.

U.S. Army Corps of Engineers
Alabama Dept. of Environmental Management (ADEM)
Alabama Dept. of Conservation and Natural Resources,
State Lands Division (ADCNR-SLD)
Alabama State Docks
City/County/Other: ________________________
ADEM Form 166 8/19 (ADEM-COE Joint Application)

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Date of
Application

Date of
Approval

Date of
Denial

13. ATTACHMENTS: In addition to the completed application form, the following attachments are REQUIRED:
Vicinity Map: Show the location of the proposed site in relation to major highways, landmarks, and nearby streets.
Drawings: Provide plan view and cross-section or elevation view drawings of the project site. Drawings must:
1. Show fully-dimensioned and accurate representations of the existing and proposed structures and activities.
2. For projects located in or adjacent to waterways, clearly indicate the location of the Mean High Water and Mean Low Water lines
(in tidally influenced areas) or the Ordinary High Water mark (in non-tidal creeks, rivers, etc.) along the shoreline or bank.
3. For projects located in or adjacent to waterways, include the width of the waterbody at the site location.

All attachments must be of reproducible quality. For hard copy applications, attachments must be on 8 ½ inch x 11 inch paper.
14. SIGNATURE OF APPLICANT OR AGENT (REQUIRED): Application is hereby made for authorization to conduct the
activities described herein. I agree to provide any additional information/data that may be necessary to provide reasonable assurance or
evidence to show that the proposed project will comply with the applicable state water quality standards or other environmental protection
standards both during construction and after the project is completed. For projects within the coastal area of Mobile and Baldwin
Counties, I certify that the proposed project for which authorization is sought complies with the approved Alabama Coastal Area
Management Program and will be conducted in a manner consistent with the program. I agree to provide entry to the project site for
inspectors from the environmental protection agencies for the purpose of making preliminary analyses of the site and monitoring
permitted works. I certify that I am familiar with and responsible for the information contained in this application, and that to the best of
my knowledge and belief such information is true, complete and accurate. I further certify that I possess the authority to undertake the
proposed activities or I am acting as the duly authorized agent of the applicant.

_______________________________________
Signature of Applicant or Agent

_________________________________
Date

18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States knowingly and willingly falsifies,
conceals, or covers up by any trick, scheme or device a material fact or make any false, fictitious or fraudulent statements or representations or makes or uses any false
writing or document knowing same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five
years or both.

15. APPLICATION SUBMISSION INFORMATION: Contact the U.S. Army Corps of Engineers prior to submitting the application
if you have any questions or to request acceptable alternate content/format. For electronic submittals (preferred method), please use
the email addresses listed below. An instruction package, example SPCC plans, and other information are available upon request.
NOTE: Fees may be required in conjunction with ADEM certification. ADEM will contact the applicant with fee requirements. Fees
may also be required by the ADCNR-SLD for dredging activities and projects impacting State-Owned Submerged Lands. ADCNR-SLD
will contact the applicant with fee requirements.
Submit the completed and signed application (with original or digital signature) and attachments to the appropriate U.S. Army Corps of
Engineers office below:
For activities in the following counties in Alabama:

For activities in all other counties in Alabama:

Baldwin, Butler, Choctaw, Clarke, Coffee, Conecuh, Covington,
Crenshaw, Dale, Escambia, Geneva, Henry, Houston, Marengo, Mobile,
Monroe, Washington, and Wilcox

(Portions of northern Alabama counties may be within the U.S. Army Corps of
Engineers Nashville District area of responsibility. Please contact the Nashville
District Regulatory Division at (615) 369-7500 for more information)

U.S. Army Corps of Engineers, Mobile District
Attention: CESAM-RD-A
Post Office Box 2288
Mobile, Alabama 36628-001
Phone: (251) 690-2658
Web: www.sam.usace.army.mil

U.S. Army Corps of Engineers, Mobile District
Attention: Regulatory Division, North Branch
218 Summit Parkway, Suite 222
Homewood, Alabama 35209
Phone: (205) 290-9096
Web: www.sam.usace.army.mil

Email: CESAM-RD@sam.usace.army.mil

Email: RD-N2@usace.army.mil

Additionally, submit a signed paper or electronic copy of the application package to the appropriate state agencies below:
For activities in the following counties in Alabama:

For activities statewide in Alabama:

Baldwin, Mobile, and Washington

(For northern counties, contact the Nashville District as noted above)

Field Operations Division, ADEM
Post Office Box 301463
Montgomery, AL 36110-2059

Coastal Section-Mobile Branch
Field Operations Division, ADEM
3664 Dauphin Street, Suite B
Mobile, AL 36608

ADCNR, State Lands Division
Coastal Section
3115 Five Rivers Boulevard
Spanish Fort, AL 36527

Phone: (251) 304-1176
Fax: (251) 304-1189
Web: www.adem.state.al.us

Phone: (251) 621-1216
Fax: (251) 621-1331
Web: www.outdooralabama.com

Email: coastal@adem.alabama.gov

ADEM Form 166 8/19 (ADEM-COE Joint Application)

Phone: (334) 394-4311
Fax: (334) 394-4326
Web: www.adem.state.al.us
Email: fieldmail@adem.alabama.gov

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Alabama State Port Authority
Attn: Harbormaster
P.O. Box 1588
Mobile, AL 36633
Phone: (251) 441-7074
Fax: (251) 441-7390
Web: www.asdd.com
Email: harbormaster@asdd.com