Clean Water Montgomery Landowner Access Permission

Type in the "Monitoring Site Identification #" found directly below the QR code on your letter.

Consent

Yes I am interested in protecting Montgomery County streams and give permission for DEP to enter my property to access and/or sample a stream.

No I am not interested in participating in the Clean Water Montgomery program and do not give permission for DEP field crews to enter my property.

Other - Please explain in the comments field below.

Consent - Other

Describe any special circumstances (e.g. dogs, cattle, fences, hunting, tenants) that field crews should be aware of when entering your property and anything else you would like to add (e.g. you no longer own this property).

Phone Number

Name, Email, and Signature

First Name

Last Name

Choose how to sign

Draw Type

Feel free to contact Mark Rockman with any questions you might have about Montgomery County's stream survey at Mark.Rockman@MontgomeryCountyMD.gov or (240) 832-3605.