HomeMy WebLinkAbout251273 11/04/15 a°���AM
�/ F. CITY OF CARMEL, INDIANA VENDOR: 370000
t CHECK AMOUNT: $********50.00*
.+; ONE CIVIC SQUARE JAMES TROSKY
�'� CARMEL, INDIANA 46032 789 ARROWWOOD DRIVE CHECK NUMBER: 251273
�___.,,,�r' CARMEL IN 46033 CHECK DATE: 11/04/15
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
250 4350900 50.00 OTHER CONT SERVICES
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RESIDENTIAL COST—SHARE APPLICATION
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CITY OF CARMEL STORM WATER USER FEE
. r RESIDENTIAL COST—SHARE APPLICATION fisB„m
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APPLICATION TYPE: —Initial Application —Installation Verification
APPLICANT NAME: APPLICANT PHONE NUMBER:
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APPLICANT EMAIL ADDRESS: APPLICANT MAILING.ADDRESS:
Carme, 1YU t�p33
PROPERTY ADDRESS: ct k7 O U e
.PROPERTY UTILITY ACCOUNT NUMBER: PROPERTY PARCEL NUMBER:
COST=SHARE APPLYING FOR:
Rain Barrel 'Rain Garden
Permeable Surface _Other approved BMP's
RIGHT OF ENTRY
Upon approval of this:application,the appiicahfag'rees�o give the'Clty of,Carmel,and Guth"orized
representatives the right to enter the premises without hindrances,and inspect any practice�being
installed,or that has been Installed,to.'receive a storm.watgr utility credit. Denial of:this right will result in
the loss of the storm water credit: Applicant's Initials
APPLI AN -SIGNATUR : DATE:
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Receipt
Name:_ r �� Amounu,
Paid: Ch:eck'# o CC Rain t3arrel#:
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Signature Date: �l �) ''
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Submit application and attachments to: City of Carmel
Engineering Department
Attn: Department of Storm water.Management
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One Civic Square
Carmel, IN 46032
stormwater@i:armeLin.gov
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Required attachments for the Residential Cost-share Iricentive
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INITIAL APPLICATION ATTACHMENTS INSTALLATION VERIFICATION ATTACHMENTS
j Sketch of Site and Location of BMP(s). Zhotos of Installation.
} Photos.of Site eceipts
j _Application Fee
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For Department of Storm water Management Use
APPLICANT NAME: PROPERTY ADDRESS:
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I DATE RECEIVED: RECEIVED BY:
E < 4
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TARGET AREA. —APPROVED
.COOL CREEK-WATERSHED COST-SHARE AMOUNT
REIMBURSEMENT SENT
_DENIED(Reason)
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j STAFFSIGNATU DATE: /
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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
James Trosky Purchase Order No.
789 Arrowwood Drive Terms
Carmel, IN 46033 Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s) Amount
10/21/2015 0 Storm Water User Fee Residential Cost Share $ 50.00
Total $ 50.00
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.
James Trosky ALLOWED 20
789 Arrowwood Drive 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
11/2/2015
Se nature
City Engineer
Cost Distribution ledger classification if Title
claim paid motor vehicle highway fund