408 Permit Request

Proposed Permit Requester Information

Name(Required)

First Last

Phone(Required)

Email(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Permit Holder

Same as Permit Requestor

Proposed Permit Holder Information

Name(Required)

First Last

Phone(Required)

Email(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Proposed Permit Location

Modification Type(Required)

Description of Proposed Modification(Required)

Provide a detailed description of the proposed modification. Include aerial view and any plans or supporting documentation.

File Upload

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Max. file size: 16 MB.

Attach supporting documentation related to this permit application.

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Geocoder

Location Address

Search for the location by entering a nearby address. You can update the exact location by moving the map pin.

Map

GPS Coordinates(Required)

Must be in decimal degrees

Engineer / Architect

Same as Permit Requestor

Engineer / Architect Information

Name(Required)

Phone(Required)

Email(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Insurance Information

Name(Required)

Phone(Required)

Email(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

*NOTE: PERMIT MAY BE SUBJECT TO PROOF OF PERMORMANCE BOND, INSURANCE BINDER, OR PROOF OF LAND OWNERSHIP, AND IS SOLEY AT THE DISCRETION OF THE TENSAS BASIN LEVEE DISTRICT HEREIN AFTER REFERRED TO AS TBLD. CERTIFICATE OF INSURANCE OR PERFORMANCE BOND NAMING TBLD AS AN ADDITIONAL INSURED FOR ALL PURPOSES INSURANCE POLICY PROVIDED THAT THE INSURER WILL IMMEDIATELY NOTIFY TBLD AND APPLICANT OF ANY CHANGES IN COVERAGE FOR ANY REASON** **Applicant acknowledges and grants unto TBLD the right to any information pursuant to this policy or performance bond and, with that right, the right to directly contact the insurer to determine any insured’s status or any other right under the policy or performance bond; provided that the insurer will immediately notify TBLD and applicant of any changes in coverage for any reason.

Your Name & Title(Required)

Your Signature(Required)

Modification of Levee Request

Proposed Permit Requester Information

Proposed Permit Holder Information

Proposed Permit Location

Engineer / Architect Information

Insurance Information

Instructions

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