318376 11/7/2017 Coq
CITY OF CARMEL, INDIANA VENDOR: 372048
ONE CIVIC SQUARE KEVIN SWEENEY CHECK AMOUNT: $ t.....
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43 _� CARMEL, INDIANA 46032 10655 HAVERSTICK ROAD CHECK NUMBER: 318376
'*. CARMEL IN 46033 CHECK DATE: 11/07/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
250 4350900 100.00 OTHER CONT SERVICES
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RESIDENTIAL COST-SHARE APPLICATION
Of Co.,�
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CITY OF CARMEL STORM WATER USER FEE
RESIDENTIAL COST-SHARE APPLICATION
APPLICATION TYPE: _Initial Application _Installation Verification
APPLICANT NfLE: i0 APPLICANT PHONE NUMBER:
APPLICANT EMAIL ADDRESS: APPLICANT MAILING ADDRESS:
PROPERTY ADDRESS:
f PROPERTY UTILITY ACCOUNT NUMBER: '` PROPERTY PARCEL NUMBER:
COST-SHARE APPLYING FOR:
f Z�ain Barr F_ _Rain Garden
—Permeable Surtace % , r 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
APPLICANT SIGNATURE: DATE:
RAj-TO
j/ 21
Submit application and attachments to: City of Carmel
Engineering Department
Attn: Department of Storm water Management
One Civic Square
Carmel, IN 46032
stormwciter@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:�//5- j/ 7 RECEIVED BY:
TARGET AREA: �&APPROVED
COOL CREEK WATERSHED /0COST-SHARE AMOUNT O
REIMBURSEMENT SENT
DENIED(Reason)
STAFF SIGNATU DATE: � -2-0
22
HAMILTON COUNTY
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7/6/2017
Hamilton County Soil and Water
1717 Pleasant Street, Suite 100
Noblesville, IN 46060
317 773-2181
soil_water@hamiltoncounty.in.gov
Name SEAS attn: Susan McRoberts
Address 10655 Haverstick Rd.
Carmel, IN 46033
Email
Descri ton Amount
2 um style rain barrels $110/barrel $220.00
2 diverters $25/diverter $50.00
*tax exempt
Tax
Shipping
Balance Due $270.00
PLEASE MAKE CHECKS PAYABLE TO HAMILTON COUNTY SWCD
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HAMILTON COUNTY
Soil& Water
7/6/2017
M i
Hamilton County Soil and Water
1717 Pleasant Street, Suite 100
Noblesville, IN 46060
317 773-2181
soil.water@hamiltoncounty.in.gov
Name SEAS attn: Susan McRoberts
Address 10655 Haverstick Rd.
Carmel, IN 46033
Email
Descri ton Amount
2 urn style rain barrels $110/barrel $220.00
2 diverters $25/diverter $50.00
*tax exempt
Tax
Shipping
Balance Due $270`00
PLEASE MAKE CHECKS PAYABLE TO HAMILTON COUNTY SWCD