Application for ERT Services – Connecticut Resource Conservation and Development

What service are you applying for?

ERT Review
Grant-writing assistance related to a previous ERT review

Name of Requesting Municipality / Agency / Organization

Requesting Applicant Name

First

Last

Title

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Fax

Contact Person for Project / Property

First

Last

Contact Person Address

Address Line 1

City

State

Zip Code

Contact Person Phone Number

Contact Person Fax Number

Contact Person Email

Land Owner of Project / Property Site

Land Owner Address

Address Line 1

City

State

Zip Code

Land Owner Phone Number

Land Owner Fax Number

Land Owner Email

Consultant or Engineer for Project / Property Site

Consultant Address

Address Line 1

City

State

Zip Code

Consultant Phone Number

Consultant Fax Number

Consultant Email

Reason for the ERT request:

Specific Property Issues to Address in the ERT Report

General Topic Areas (FREE)

Please select all that apply:

Land Use Context / Zoning
State Plan of C&D Consistency
Funding / Grant Strategy
Soils
Farmland Preservation
Agriculture
Community Garden
Water Quality / Supply
Topography
Archaeology
Historical Significance
Coastal Resources
Lakes / Ponds
Traffic / Access
Geology
Property - Trail Mapping
Energy

Specific Topic Areas (Small Surcharge May Apply)

Please select all that apply:

Wetlands
Site Design
Brownfields
Economic Development
River Ecology
Fisheries
Wildlife
Herpetology
Forestry
Invasive Species
Erosion and Sediment Control
Storm Water Drainage
Watershed
Landscape Ecology
Cultural Ecology
Architectural
Open Space Management Plan (please contact us for a subsidized cost estimate)
Open Space Workshop Facilitation (please contact us for a subsidized cost estimate)

Please let us know if you have other concerns about the property that we may be able to provide free or find an expert to help evaluate the resource.

Summary of Proposed Project (Please include site location, acreage and brief description):

When is the ERT report needed?

Does the ERT request include any activities that will be regulated by the commissioner of the Department of Environmental Protection (DEP)?

If yes, please describe regulated activities:

Have any town staff or consultants prepared reports, mapping, or additional information concerning the property?

If yes, please list them here in citation form and attach a copy:

Upload files

Drag & Drop Files, Choose Files to Upload

Does your town/organization employ any professional staff or consultants such as an engineer or planner?

If yes, please list their name, position, address and telephone number:

Please note: The information collected is included in a report that is distributed to CTDEEP and the State Library. Three copies of the report are provided at no cost to the requester and are posted on the CTERT website. Additional copies are $10/each.

What grant do you need technical assistance applying to?

Name of Grant Funding Agency

Deadline of Application

I endorse this request to the Connecticut ERT and agree to all the terms listed here within the application.

Name and Title of the Chief Elected Official and/or Requesting Chairman

Date / Time

Date

Time

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