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HomeMy WebLinkAbout249351 09/09/15 •Cqq CITY OF CARMEL, INDIANA VENDOR: 369805 ® 'I ONE CIVIC SQUARE DOROTHY LITTLE CHECK AMOUNT: $*******100.00* is ,o CARMEL, INDIANA 46032 11518 BLOSSOM WAY CHECK NUMBER: 249351 9raN CARMEL IN 46032 CHECK DATE: 09/09/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 250 4350900 STORM CREDIT 100.00 CREDIT RESIDENTIAL COST-SHARE APPLICATION 0 gvtd f CCITY OF CARMEL STORM WATER USER FEE RESIDENTIAL COST-SHARE APPLICATION APPLICATION TYPE: i Initial ApplicationInstallation Verification APPLICANT NAME: APPLICANT PHONE NUMBER: 1Jp2o y 1 /7TZi �7 /9 , 7 .35 APPLICANT EMAIL ADDRESS: i APPLICANT MAILING ADDRESS: yc, kv, Ca�7 PROPERTY ADDRESS: PROPERTY UTILITY ACCOUNT NUMBER: PROPERTY PARCEL NUMBER: 18t ! 3 � �a� 2 17 - 13- 0.2 - 02 -" COST-SHARE APPLYING FOR: 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 representatives the right to enter the 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 SIGNATURE: DATE: 1 zi Submit application and attachments to: City of Carmel Engineering Department Attn:Department of Storm water Management One Civic Square Carmel,IN 46032 stormwdter@connel.in.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: _ PROVED fe✓� COOL CREEK WATERSHED COST-SHARE AMOUNT REIMBURSEMENT SENT DENIED(Reason) STAFF SI TUR� DATE: 22 }1" ;,a,w d. .-"7' Y '"x's,7s;'.: ,�" "�"'N.><,'rr,-.,,,. ;."u,»w` a ". .�;� 'S� 'M+, , ➢ bra, ,`a;'W .cr,,#'`T.'''t �.,.„„S,�vi;,,.;,,.;,�;..;,.;;�,< �.� av:� ,'�,.::��\»« a ia� :r, .,t. ,.x; urv;}>�,^rc?`;'�',+x;'r;t'a.„ ��� afr\_ .,�'� at" .;� s. 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Y ) kf��.. r C",q� R\ qhs"�a^qs«\ �""1.�� ga w'�t w tS. °�w q',�X� ,�' K Pt dt z td s � wP � t •Ci`aYa.,.�. y' a.„7tAv ,• 9 a,M;" Y„ t;"s "Slt t '�;„ " w,r q""t•py„y� ,� 3'�•` � 'r,'4t4 X.'. „hm ek� 4 ,} K s n�'v" 4 k t��h�v� "j "a � 4a „h i 9 m 4 8 < �� � 9�#\ � i f } h t 8 S ..Pj';3xtyw�.t',txp�l"sk Na '4 .t,rM�Ge 4 + . 8 'T ,� "2 1 4 v" � 4�v� ��"�\X4\ t �: e(S""ad`"y"„�^���k¢�.�: �,1 „t�A�'t,th+�'�M„`4 a t9pk.'k"1 �r ^�,� ;'� „\°9i"X i," 1h r�tNz "j" rA Prescribed by Stai 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 Dorothy Little Purchase Order No. 11518 Blossom Way Terms Carmel, IN 46032 Date Due Invoice Invoice Description Date Number. (or note attached invoice(s) or bill(s) Amount 8/11/2015 0 Storm Water User.Fee Residential Cost Share $ 100.00 Total $ 100.00 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. ;7orothy Little ALLOWED 20 11518 Blossom Way IN SUM OF $ Carmel, IN 46032 $ 100.00 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 $ 100.00 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 Si ature City Engineer Cost Distribution ledger classification if Title claim paid motor vehicle highway fund