The conversion permit application shall be in a form prescribed by the Director and shall require but not be limited to the following information: the name and address of the applicant; the name and address of the Timberland owner of record; the name and address of the Timber Owner; the legal description, general Plan designation, and zoned status of the proposed conversion area; the proposed future use or uses of said area; the dates when conversion is to be commenced and completed; the approximate number of acres to be converted; the zoned status of adjacent property; a description of other land owned by the applicant in the surrounding area which could accommodate the proposed use or uses; together with a copy of the conversion Plan. The application shall be executed under penalty of perjury.