HomeMy WebLinkAbout249226 09/09/15 CITY OF CARMEL, INDIANA VENDOR: 369817
b ONE CIVIC SQUARE JEFF AND KAHTY DEAKYNE CHECK AMOUNT: $ ....."50.00'
=Q CARMEL, INDIANA 46032 14224 ARCADIAN CIRCLE CHECK NUMBER: 249226
CARMEL IN 46033 CHECK DATE: 09/09/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
250 4350900 50.00 STORMWATER CREDIT
RESIDENTIAL COST-SHARE APPLICATION
of Ca\
%- CITY OF CARMEL STORM WATER USER FEE ,br
RESIDENTIAL COST-SHARE APPLICATION
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APPLICATION TYPE: _Initial Application Installation Verification
APPLICANT NAME: APPLICANT PHONE NUMBER:
JEFF +KWIi 4 . �a - 0149.5
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APPLICANT EMAIL ADDRESS: APPLICANT MAILINGAD�DRfEn1��
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PROPERTY ADDRESS: , ZI
PROPERTY UTILITY ACCOUNT NUMBER:; PROPERTY PARCEL NUMBER:
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COST-SHARE APPLYING FOR:
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Rain Barrel —Rain Garden
Permeable Surface Other approved BMP's
RIGHT OF ENTRY
Upon approval of this application,the applicant agrees to give the City of Carmel and authorized I
representatives the right to enter fhe premises without hindrances,and inspect any practice being
installed,or that has been installed,to receive a storm water utility credit. Denial of this right will result in
the loss of the storm water credit. Applicant's Initials
PLICANT GN RE: / DATE:
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Submit application and attachments to: City of Carmel
Engineering Department
Attn:Department of Storm water Management
One Civic Square
Carmel,IN 46032
stormwdtei@carmeLin.gov
Required attachments for the Residential Cost-share Incentive
INITIAL APPLICATION ATTACHMENTS INSTALLATION VERIFICATION ATTACHMENTS
—Sketch of Site and Location of BMP(s) Photos of Installation
_Photos of Site _Receipts
_Application Fee
For Department of Storm water Management Use
APPLICANT NAME: PROPERTY ADDRESS:
DATE RECEIVED: RECEIVED BY:
TARGET AREA: V
PPROVED
_COOL CREEK WATERSHEDOST-SHARE AMOUNT (J
REIMBURSEMENT SENT
DENIED(Reason)
STAFF SIGN U E: DATE:
22
Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom,
rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Jeff and Kathy Deakyne Purchase Order No.
14224 Arcadian Circle Terms
Carmel, IN 46033 Date Due
Invoice Invoice Description
Date Number; (or note attached invoice(s) or bill(s) Amount
8/24/2015 0 Storm Water User Fee Residential Cost Share $ 50.00
Total $ 50.00
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5-11-10-1.6.
20
Clerk-Treasurer
VOUCHER NO WARRANT NO.
Jeff and Kathy Deakyne ALLOWED 20
14224 Arcadian Circle IN SUM OF $
Carmel, IN 46033
$ 50.00
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT# I hereby certify that the attached invoice(s), or
0 0 250-4350900 $ 50.00 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
9/4/2015
Sign ture
City Engineer
Cost Distribution ledger classification if Title
claim paid motor vehicle highway fund