Each permit by notification form filed with the department shall include the following information:

1. (a) The information required by under RSA 483-B:5-b, I(a), reprinted in Appendix C, subject to the following:

   1. (1) The name of the property owner shall be the legal name of each property owner as it appears on the deed of record;
   2. (2) The address of the property owner shall be the property owner’s regular mailing address; and
   3. (3) The waterbody named shall be the waterbody that causes the property to be subject to RSA 483-B; and

2. (b) The additional contact and project information listed below:

   1. (1) The property owner’s daytime telephone number and e-mail address, if any;
   2. (2) If an agent is filing the notification on behalf of the property owner, the agent’s name, mailing address, daytime telephone number, and e-mail address, if any, together with a statement signed by the property owner certifying that the property owner has authorized the agent to act on the property owner’s behalf for purposes of the notification;
   3. (3) A narrative description of the project;
   4. (4) The total area of protected shoreland to be impacted by the project in square feet;
   5. (5) The area of net change in impervious surface resulting from the project in square feet; and
   6. (6) An initialed agreement to adhere to those conditions applicable to all projects as described in Env-Wq 1406.19.

Source. (See Revision Notes #1 and #2 at chapter heading for Env-Wq 1400) #12062 eff 12-17-16