318383 11/07/2017 �,�bf. CITY OF CARMEL, INDIANA VENDOR: 372046
ONE CIVIC SQUARE COLLEEN TURNER CHECK AMOUNT: $**......75.00*
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CARMEL, INDIANA 46032 521 CONCORD LANE CHECK NUMBER: 318383
'+.,�roN. CARMEL IN 46032 CHECK DATE: 11/07/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
250 4350900 75.00 OTHER CONT SERVICES
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Name: (V--4'-Z-4"_ ��• r �� Amount:�
Paid: Check# Cash CC Rain Barrel#:
Signature: Date:
APPLICATION TYPE: _Initial Application _Installation Verification
APPLICANT NAME: APPLICANT PHONE NUMBER:
APPLICANT EMAIL ADDRESS: APPLICANT MAILING ADDRESS:
Co 1 leen 6?Lf q
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PROPERTY ADDRESS: ID
PROPERTY UTILITY ACCOUNT NUMBER: PROPERTY PARCEL NUMBER:
COST-SHARE APPLYING FOR:
L/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 tility credit. Denial of this right will result in
the loss of the storm water credit. Applicant's Initials
APPLICANT SIGNATURE: DATE:
21
Submit application and attachments to: City of Carmel
Engineering Department
Attn:Department of Storm water Management
One Civic Square
Carmel, IN 46032
stormwater@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: -J-1—) ) --�
kr 2O J 1 ! ', /f 9 J'`*C—s
TARGET AREA: Y�,APPROVED
COOL CREEK WATERSHED &OST-SHARE AMOUNT
REIMBURSEMENT SENT
DENIED(Reason)
STAFF SIGNATUR DATE:
/o /-2- 11 7
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