Exemption Request Form REQUEST FOR DETERMINATION OF NON-APPLICABILITY***IMPORTANT – READ ALL INFORMATION CAREFULLY***Name(Required)Property Owner First Last Owner Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Property Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Owner Address Municipality(Required)Property Address MunicipalityPhoneProperty BlockEmail Address Property LotPlease check choice of delivery:(Required)Letter will be sent to one (1) email address only. Pick Up Email Project Description (Check one):(Required) Demolition Construction Agriculture/Other Graphically denote the total estimated soil disturbance including building footprint, driveways, parking areas, sidewalks, utilities, grading, staging/stockpiling areas, stabilized construction entrance etc. – What will the total soil disturbance be in square feet?(Required)Submit a legible copy of a site plan or grading/plot plan with a scale and graphically denote a limit of disturbance line.(Required)Please provide a narrative of work in box below.Digital Signature(Required) I, the undersigned, request that the subject land disturbance be reviewed for determination of non-applicability of the NJ Soil Erosion and Sediment Control Act (N.J.S.A. 4:24-et seq.) I understand that I am responsible to provide the required information and review fee as requested below. I further understand that should the activity deviate from the information provided and/or exceed 5,000 square feet of land disturbance, any determination of non- applicability will be rendered VOID and will require a reassessment of the land disturbance by the District. Non-applicability means the subject land disturbance does not meet the definition of a project under the Act and as such does not require formal Soil Erosion and Sediment Control Plan CertificationOwner Name(Required) First Last Date(Required) **IMPORTANT NOTICE** Effective July 1, 2026, letters of determination will be issued by email or pick-up only. *Letter will be sent to one (1) email address only.
