Pre-screen Form

In order to determine if the proposed activity will require a Service Provider Letter, the applicant may apply for a Prescreening Site Assessment. If no Water Quality Sensitive Areas appear to exist on or within 200 feet of the site, then no further site assessment or service provider letter is required. See Environmental Review Permit Process.

Property Information

You must enter either a Tax Lot ID (e.g. 1S234AB01400) or Site Address, but you do not have to enter both.

Owner Information

Applicant Information

Development Activity

This is a required field. Please select one development activity or enter a description for other.

Check all that apply

Off-site Work

Will the project involve any off-site work?

Site Plan

Would you like to submit a site plan? Including a site plan with your submittal plan will reduce your review time.

Additional Comments


By submitting this form the Owner, or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site.

Additionally, I certify that I am familiar with the information contained in this document, and to the best of my knowledge and belief, this information is true, complete, and accurate.

Entries missing a fax number will be mailed to the Applicant's postal address. Submittals returned by postal mail will take additional time beyond our standard working timeframe to reach the applicant.