What is the Land Disturbance Permit Application for?

It requests a Jefferson County land disturbance permit and collects project location, parcel, disturbed-acreage, property owner, and contractor details.

Who completes this application?

The form includes information for the property owner and contractor, along with the printed name, signature, and date of the applicant.

How do I submit the Land Disturbance Permit Application?

Submit the signed application by email to mnelson@jeffersoncountyga.gov or in person at 1200 School Street, Louisville, GA 30434.

Do I need a notary for the Land Disturbance Permit Application?

No. The application asks the applicant to sign and date it, and does not state that any attachment or related step must be notarized or sworn.

Jefferson County, GA · Jefferson County

No notary required

Land Disturbance Permit Application

Property owners and contractors use this application to request a Jefferson County land disturbance permit and provide project, property, and contact information.

At a glance

Issued by: City of Jefferson County · Jefferson County, Jefferson County, Georgia
Notarization: Not required: file this form without a notary.
Official source: jeffersoncountyga.gov
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

The Jefferson County Building Inspection Department application requests a permit for land disturbance and records the construction location, parcel number, disturbed acres, property owner, and contractor information. The applicant signs and initials statements accepting responsibility for the approved erosion and sediment control plan and granting county personnel entry to inspect and monitor the property. The form also includes county approval fields.

Who needs it

Property owners or contractors applying for a Jefferson County land disturbance permit can use this form to provide project details and sign the required statements.

How to submit it

Submit the signed application by email to [email protected] or in person at 1200 School Street, Louisville, GA 30434, as directed on the form.

About notarization

This application is signed without a notary; it asks the applicant to sign and date, with no notarized attachment or sworn step stated.

How to submit this form

1
Download the Application
Download the Land Disturbance Permit Application PDF.
2
Complete the Project Details
Enter the construction location, parcel number, disturbed acres, property owner information, and contractor information.
3
Review and Sign
Read and initial the statements, then print your name, sign, and date the application.
4
Submit the Application
Email the signed application to [email protected] or deliver it in person to 1200 School Street, Louisville, GA 30434.

Frequently asked questions

What is the Land Disturbance Permit Application for?: It requests a Jefferson County land disturbance permit and collects project location, parcel, disturbed-acreage, property owner, and contractor details.
Who completes this application?: The form includes information for the property owner and contractor, along with the printed name, signature, and date of the applicant.
How do I submit the Land Disturbance Permit Application?: Submit the signed application by email to [email protected] or in person at 1200 School Street, Louisville, GA 30434.
Do I need a notary for the Land Disturbance Permit Application?: No. The application asks the applicant to sign and date it, and does not state that any attachment or related step must be notarized or sworn.

Need something notarized?

This Land Disturbance Permit Application doesn’t need a notary, but if you have another Jefferson County form that does, a commissioned online notary can help.