249356 09/09/15 City of Carmel
Engineering Department
One Civic Square
Carmel, IN 46032
Remit to:
Sue Maki
317 2nd Avenue NE
Carmel, IN 46032
Invoice Date Invoice# Project Name Amount Paid
7/1/2015 0 Storm Water User Fee Residential Cost Share $ 150.00
Check Total $150.00
I
Prepared by City of Carmel 9/3/2015
RESIDENTIAL COST-SHARE APPLICATION
< of Ca'.
CITY OF CARMEL STORM WATER USER FEE
RESIDENTIAL COST-SHARE APPLICATION
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APPLICATION TYPE: ^Initial Application IV/Installation Verification
-APPLICANT NAME: APPLICANT PHONE NUMBER:
Tommi C pS �c`SY
C ; 317- 75-0 -7 3
� u mak
APPLICANT EMAIL ADDRESS: APPLICANT MAILING ADDR SS: t
-� 317
�u X11 � C� r naeJ T(\j '1 0 3a
PROPERTY ADDRESS: 3 _ 11 cl, �j
-PROPERTY-UTILITY ACCOUNT NUMBER: PROPERTY PARCEL NUMBER:
i
U70V161
COST HARE APPLYING FOR:
Rain Barrel C a� !Rain Garden
Permeable Surface / —Other approved BM P'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 stormater utility credit. Denial of this right will result in
the loss of the storm water credit. Applicant's Initials pig
APPLI ANT SIGNA U E: DATE:
_3 [ 5-
21
Submit application and attachments to: City of Carmel
Engineering Department
Attn: Department of Storm water Management
One Civic Square
Carmel, IN 46032
stormwater@cormel.in.gov
Required attachments for the Residential Cost-share Incentive
INITIAL APPLICATION ATTACHMENTS ZIN ALLATION VERIFICATION ATTACHMENTS
—Sketch of Site and Location of BMP(s) Photos of Installation
Photos of Site �Keceipts --- Ca 6 c ct
_.Application Fee Cj W e bC, Ye- C/o ti V
L-09 O11 c� t �OC,tI r -
For Department of Storm water Management Use
APPLICANT NAME: PROPERTY ADDRESS:
DATE RECEIVED: . I r RECEIVED BY:
TARGET AREA: _APPROVED
COOL CREEK WATERSHED ���n _COST-SHARE AMOUNT
JAS &I _REIMBURSEMENT SENT
DENIED(Reason)
STAFF SIG E: DATE: / n
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
Sue Maki Purchase Order No.
317 2nd Avenue NE Terms
Carmel, IN 46032 Date Due
Invoice Invoice Description
Date Number, (or note attached invoice(s) or bill(s) Amount
7/1/2015 0 Storm Water User Fee Residential Cost Share $ 150.00
Total $ 150.00
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
I
VOUCHER NO WARRANT NO.
.Sue Maki ALLOWED 20
.317 2nd Avenue NE IN SUM OF $
Carmel, IN 46032
$ 150.00
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 $ 150.00 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.
Signa ure
City Engineer
Cost Distribution ledger classification if Title
claim paid motor vehicle highway fund