APPLICATION FOR DOCK / SEAWALL / RECLAMATION/ OTHER USAGE OF RESERVE AND SEABED 1. Applicant* First Last Contact info: Address:* Street Address Address Line 2 City District AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Cell No.:*Email Address:* 2. For and on behalf of (LICENSEE):*Social Security:*Cell No.:*Email Address:* Hereby apply for permission to utilize the 66 feet reserve/Seabed as follows: 3. TYPE OF PROPOSED STRUCTURE/ACTIVITY:*4. Location of Property:*5. USE:* Residential Commercial Other Other:6. LENGTH (Feet):* < 100 100 - 200 200 - 300 Other Other:7. Area: (Square Feet):* =< 10,900 >10,900 Additional Information Required : 8. Place √ in the appropriate box indicating that the following have been submitted:* Copy of Land Document Copy of ID Detailed Plan showing dimensions of Proposed Construction / Works. Location Map showing location of Proposed Construction in relation to property (show location of nearby Docks /Seawall if any) Recommendation from City / Town / Village Council and Home Owners Association (if applicable) Company Documents(if applicable) (e.g. Company Certificate, Memorandum of Association and Article of Association) Input from relevant agencies (if applicable) (e.g. Department of Environment, Geology Department, etc.) Development Declaration duly signed in front of a Justice of the Peace Authorization Letter (if applicable) Attach Documents:* Drop files here or Accepted file types: jpg, png, pdf. Consent* I agree to the privacy policy.I hereby apply for a dock/ seawall / reclamation/ other usage of reserve and seabed under the National Lands Act and declare that to the best of my knowledge and belief the particulars set out in this application are true and correct.APPLICANT*Date* DD MM YYYY Official use:Received this:Officer* Application will not be accepted if required documents are not attached. NOTE: A site inspection is required before your application is processed. For official use only Recommended Signature Date Principal Planner YES NO Commissioner YES NO Hon. Minister YES NO CAPTCHA
