Applicant 

 Name : 



DATA FORM 3 



ATYPICAL SITUATIONS 



Application 

 Number : 



Location: 



Plot Number: 



Project 

 Name : 



Date: 



A. VEGETATION : 



1. Type of Alteration: 



2. Effect on Vegetation: 



3. Previous Vegetation: 



(Attach documentation) 



4. Hydrophytic Vegetation? Yes 

 B. SOILS : 



1. Type of Alteration: 



No 



2. Effect on Soils: 



3. Previous Soils: 



(Attach documentation) 



4. Hydric Soils? Yes_ 

 C. HYDROLOGY : 



1. Type of Alteration: 



No 



2. Effect on Hydrology: 



3. Previous Hydrology: 



(Attach documentation) 



4. Wetland Hvdrologv? Yes 



No 



Characterized Bv : 



B4 



