JOINT APPLICATION AND NOTIFICATION U. S. …

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ADEM form 166 8/19 (ADEM-COE JOINT APPLICATION ) Page 1 of 3 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 : ___________ / _______ / ___________ month day year APPLICATION Number:_______________________________ (Agency Use Only) INFORMATION:Name: ________________________________________ __Company: _______________________________________M ailing Address: ________________________________________ ________________________________________ ________________________________________ _______Telephone Number and Email (during business hours):A/C ( ) ____________________________________Emai l: LOCATION:Street Address: ________________________________City/Com munity: ______________________________County: ______________________________________Na me of Waterway: ____________________________Latitude: _____________________________________Lon gitude.

adem form 166 8/19 (adem-coe joint application) page 1 of 3 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

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