DPNR- DP Application — Form II FOR OFFICE USE

Page lof 5 =,



Date received:



Date deemed complete:

Reviewed by:



DEPARTMENT OF PLANNING AND NATURAL RESOURCES

DIVISION OF BUILDING PERMITS

45 MARS HILL, Frederiksted, St. Croix, VI 00840

Cyril E. King Airport, Charlotte Amalie, VI00801

PHONE: STX: (340) 773-1082, FAX: (340) 773-9310 ! STT: (340) 774-3320, FAX (840) 714-9549



Earth Change Permit Application Form II-Single Lot



Note fo all applicants: A thirty day period shall apply to the review of an earth change plan by DPNR. The

30-day period shall begin with the date of reception indicated above. However, termination of the 30-day

period shall not give inferred or automatic approval to the application (12 Vi Rules and Regs. §532-12).



SECTION A: PROJECT INFORMATION



Owner(s) Name as listed on Deed:

Submit Proof of Legal Interest: (Copy of Deed/Lease with Covenants & Restrictions



or Purchase Agreement/Land Contract)



Physical Address:

Mailing address of owner:

Telephone #: (H) (W) (Cell)

Plot No:

Estate:



Acreage:



Parcel Identification Number:

Submit a copy of property tax bill or tax clearance letter (contact Tax Assessor’s

Office: 773-6459 (C’ Sted), 772-3115 (F’Sted), 776-8505 (STT/STJ) for information.)



Zoning:



Name and telephone number of project designer, architect, engineer, or draftsman, (Site

plan must be stamped by a certified licensed architect, draftsman or engineer.



Name & Phone License Number:



Name and telephone number of certified earthwork contractor.




Seller’s name



Address



Date



Dear Sir or Madam:



I am the current owner of



(property description, size and location).



(Buyer’s name) has entered into a land contract with

me for the purchase of said property. I hereby grant him/her permission to build on the property,

provided that he/she acquire the necessary permits.



This letter does not void any term or condition outlined in the land contract. If you have

any questions, please contact me at (e-mail or

telephone number).



Sincerely,



(Seller’s name)



Notary



Subscribed, sworn to and acknowledged before me by the said ;

(seller’s name), this____ day of



(month) (year).



Notary Public

My Commission Expires on: